Provider Demographics
NPI:1013937978
Name:TITUS, JEFFREY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:TITUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDREN'S
Mailing Address - Street 2:ONE CHILDREN'S PLACE, SUITE 3 SOUTH-32
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1077
Mailing Address - Country:US
Mailing Address - Phone:314-454-6069
Mailing Address - Fax:314-454-4576
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:3S32
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6069
Practice Address - Fax:314-454-4576
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004512103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
199574OtherBCBS