MEDICARE: TITUS TUBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2019002360	MO

General Provider Information

NPI Number	:	1194288605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TITUS TUBB

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:	636-224-1210
Fax Number	:	636-246-1008

Provider Business Practice Location Address
First Line	:	1125 E CHERRY ST
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1520
Country	:	US
Telephone Number	:	636-224-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	07/08/2025

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