Provider Demographics
NPI:1598063125
Name:DUTTON, NICOLE C (MS, BCBA, LBA, COBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MS, BCBA, LBA, COBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:C
Other - Last Name:DELANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA, COBA
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:833-288-4761
Mailing Address - Fax:
Practice Address - Street 1:2785 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-6501
Practice Address - Country:US
Practice Address - Phone:216-278-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00415103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty