Provider Demographics
NPI:1366424467
Name:TITUS, DONNA G (PSY D)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:G
Last Name:TITUS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2212
Mailing Address - Country:US
Mailing Address - Phone:502-459-7536
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 562
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:502-896-6863
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY809103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
17548OtherCIGNA
90068OtherUHC UBH
044445OtherVALUE OPTION MHS
179578OtherCOMPSYCH
000000042994OtherANTHEM
4340889OtherAETNA
A035941OtherVALUE OPTION VENDER
085189000OtherMAGELLAN
235878OtherMHN
PVPB128223OtherAPS HEALTHCARE
IN100387310Medicaid
KY89009237002Medicaid
KYCP00041Medicare PIN