Healthcare Provider Details

I. General information

NPI: 1184208092
Provider Name (Legal Business Name): AUTUMN TITUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W NORFOLK AVE STE 201
NORFOLK NE
68701-5221
US

IV. Provider business mailing address

333 W NORFOLK AVE STE 201
NORFOLK NE
68701-5221
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2030
  • Fax: 402-379-3933
Mailing address:
  • Phone: 402-379-2030
  • Fax: 402-379-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1547
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: