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 | 1041C0700X | Social Worker | Clinical | 22727 LCSW | CALIFORNIA | No |
| 2 | 1041C0700X | Social Worker | Clinical | 117-C LCSW | NEVADA | No |
| 3 | 106H00000X | Marriage & Family Therapist | | 0275 MFT | NEVADA | No |
| 4 | 1041C0700X | Social Worker | Clinical | LCS22727 | CALIFORNIA | No |
| 5 | 1041C0700X | Social Worker | Clinical | 7118299-3502 CSW | UTAH | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | MFT 0275 | OTHER | NEVADA | BOARD OF EXAMINERS OF MFT |
| 2 | LCSW 117-C | OTHER | NEVADA | BOARD OF EXAMINERS OF SOCIAL WORKERS |
| 3 | 7118299-3502 CSW | OTHER | UTAH | DOPL UTAH |
| 4 | LCS22727 | OTHER | CALIFORNIA | LCSW LICENSE |