Provider Demographics
NPI:1700522307
Name:WAKYI, TITUS
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:
Last Name:WAKYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 181
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2879
Mailing Address - Country:US
Mailing Address - Phone:612-259-7715
Mailing Address - Fax:612-259-7889
Practice Address - Street 1:3905 LANCASTER LN N APT 228
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1727
Practice Address - Country:US
Practice Address - Phone:612-458-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health