Provider Demographics
NPI:1639531031
Name:TUFF, GLADYS RENAEE (LCDC III)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:RENAEE
Last Name:TUFF
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5595
Mailing Address - Country:US
Mailing Address - Phone:614-242-1284
Mailing Address - Fax:
Practice Address - Street 1:455 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5595
Practice Address - Country:US
Practice Address - Phone:614-242-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH090740104100000X
OH161046-3101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker