Provider Demographics
NPI:1366970915
Name:TITUS, BROOKE NICHOLE (LADC)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:NICHOLE
Last Name:TITUS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:NICHOLE
Other - Last Name:WEEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLADC
Mailing Address - Street 1:110 N BAILEY AVE
Mailing Address - Street 2:PO BOX 1209
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-1209
Mailing Address - Country:US
Mailing Address - Phone:308-534-6029
Mailing Address - Fax:
Practice Address - Street 1:110 N BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-1209
Practice Address - Country:US
Practice Address - Phone:308-534-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1496101YM0800X
171M00000X
NE1346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator