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 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 2 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 3 | 251B00000X | Case Management | | | | No |
| 4 | 133V00000X | Dietitian, Registered | | | | No |
| 5 | 251S00000X | Community/Behavioral Health | | | | No |
| 6 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 7 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 8 | 104100000X | Social Worker | | | | No |
| 9 | 225X00000X | Occupational Therapist | | | | No |
| 10 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 11 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 12 | 175T00000X | Peer Specialist | | | | No |
| 13 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | | | No |
| 14 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | Yes |
