Healthcare Provider Details

I. General information

NPI: 1922898907
Provider Name (Legal Business Name): TITUS MOTEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17820 MOUND RD STE B
CYPRESS TX
77433-4903
US

IV. Provider business mailing address

825 USENER ST APT 541
HOUSTON TX
77009-7456
US

V. Phone/Fax

Practice location:
  • Phone: 651-505-3273
  • Fax:
Mailing address:
  • Phone: 832-898-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number40848
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40848
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number72931
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: