Provider Demographics
NPI:1003275652
Name:RUTAN, ROBIN (LPCCS, LSW, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:RUTAN
Suffix:
Gender:F
Credentials:LPCCS, LSW, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 E KOSSUTH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206
Mailing Address - Country:US
Mailing Address - Phone:614-582-9456
Mailing Address - Fax:
Practice Address - Street 1:2080 CITYGATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3591
Practice Address - Country:US
Practice Address - Phone:614-445-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC991726101YA0400X
OHE.080003LPCC101YP2500X
OHS.0013326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty