Healthcare Provider Details

I. General information

NPI: 1780823971
Provider Name (Legal Business Name): KATHLEEN ANN TITHOF LLMSW, CTRS, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 EAST LANSING DRIVE
EAST LANSING MI
48823
US

IV. Provider business mailing address

5411 MANCELONA DRIVE
GRAND BLANC MI
48439
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-1616
  • Fax:
Mailing address:
  • Phone: 810-953-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086333
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: