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 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 2 | 103TC0700X | Psychologist | Clinical | | | No |
| 3 | 103TC2200X | Psychologist | Clinical Child & Adolescent | | | No |
| 4 | 103TF0000X | Psychologist | Family | | | No |
| 5 | 1041C0700X | Social Worker | Clinical | | | No |
| 6 | 207Q00000X | Family Medicine | | | | No |
| 7 | 207QA0401X | Family Medicine | Addiction Medicine | | | No |
| 8 | 207R00000X | Internal Medicine | | | | No |
| 9 | 207RA0401X | Internal Medicine | Addiction Medicine | | | No |
| 10 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | ILLINOIS | Yes |
| 11 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 12 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 13 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 14 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 15 | 364SP0808X | Clinical Nurse Specialist | Psychiatric/Mental Health | | | No |