Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 101YP2500X | Counselor | Professional | | | No |
| 2 | 101YS0200X | Counselor | School | | | No |
| 3 | 1041C0700X | Social Worker | Clinical | | | No |
| 4 | 1041S0200X | Social Worker | School | | | No |
| 5 | 106H00000X | Marriage & Family Therapist | | | | No |
| 6 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 7 | 251S00000X | Community/Behavioral Health | | | | No |
| 8 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 9 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 10 | 261QP2300X | Clinic/Center | Primary Care | 163407-1205 | UTAH | No |
| 11 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | 11273 | UTAH | Yes |
| 12 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | | | No |
| 13 | 323P00000X | Psychiatric Residential Treatment Facility | | | | No |
| 14 | 324500000X | Substance Abuse Rehabilitation Facility | | | | No |
| 15 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
