Individual
DR. JACQUELINE MEZZA TITUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
151 PSYCHOLOGY BLDG, MICHIGAN STATE PSYCHOLOGICAL CLINIC, EAST LANSING, MI 48824-1116
(517) 599-4934
Mailing address
151 PSYCHOLOGY BUILDING, MSU PSYCHOLOGICAL CLINIC, EAST LANSING, MI 48824
(517) 599-4934
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301014282
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
6301013657
MI
Other
Enumeration date
08/14/2008
Last updated
10/07/2009
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