Provider Demographics
NPI:1689396806
Name:TITSWORTH, GAYLA
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:
Last Name:TITSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1723
Mailing Address - Country:US
Mailing Address - Phone:618-252-9036
Mailing Address - Fax:
Practice Address - Street 1:1200 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1723
Practice Address - Country:US
Practice Address - Phone:618-252-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor