MEDICARE: MARY TITUS

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1861910994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TITUS

Provider Business Mailing Address
First Line	:	2995 RYAN DR SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-5157
Country	:	US
Telephone Number	:	503-371-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2995 RYAN DR SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-5157
Country	:	US
Telephone Number	:	503-371-7701
Fax Number	:

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

Provider Enumeration Date	:	09/09/2017
Last Update Date	:	07/14/2021

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Directions to “ MARY TITUS ” Practice Location

Language	Start Address	Practice Location

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