Provider Demographics
NPI:1265054316
Name:VUTHA, NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VUTHA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:K
Other - Last Name:LAURIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 CRANFORD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1252
Mailing Address - Country:US
Mailing Address - Phone:614-307-7472
Mailing Address - Fax:
Practice Address - Street 1:4725 PARKWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6401
Practice Address - Country:US
Practice Address - Phone:614-655-3354
Practice Address - Fax:614-317-4692
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2512354101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator