| Stacey Titus Pllc | |
|
5440 W Franklin Rd Ste 201 Boise ID 83705-6434 | |
| (208) 860-2656 | |
| Not Available |
| Full Name | Stacey Titus Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 5440 W Franklin Rd Ste 201, Boise, Idaho |
| Authorized Official Name and Position | Stacey Titus (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2088602656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Titus Pllc 11868 W Gunsmoke Dr Boise ID 83713-4753 Ph: (208) 860-2656 | Stacey Titus Pllc 5440 W Franklin Rd Ste 201 Boise ID 83705-6434 Ph: (208) 860-2656 |
| NPI Number | 1417577412 |
|---|---|
| Provider Enumeration Date | 04/20/2020 |
| Last Update Date | 04/20/2020 |
| Certification Date | 04/20/2020 |
| Medicare PECOS PAC ID | 8224453410 |
|---|---|
| Medicare Enrollment ID | O20200805001338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417577412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacey L Titus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801244843 PECOS PAC ID: 4082950688 Enrollment ID: I20190117001958 |
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