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 | 101YM0800X | Counselor | Mental Health | | | No |
| 2 | 251B00000X | Case Management | | | | No |
| 3 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 4 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
| 5 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 6 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 7 | 261QR0401X | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | | | No |
| 8 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | Yes |
| 9 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
| 10 | 323P00000X | Psychiatric Residential Treatment Facility | | | | No |
| 11 | 252Y00000X | Early Intervention Provider Agency | | | | No |
| 12 | 251S00000X | Community/Behavioral Health | | | | No |