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 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 3 | 103T00000X | Psychologist | | | | No |
| 4 | 103TB0200X | Psychologist | Cognitive & Behavioral | | | No |
| 5 | 103TP0016X | Psychologist | Prescribing (Medical) | | | No |
| 6 | 103TP0814X | Psychologist | Psychoanalysis | | | No |
| 7 | 106H00000X | Marriage & Family Therapist | | | | No |
| 8 | 202D00000X | Integrative Medicine | | | | No |
| 9 | 207QA0505X | Family Medicine | Adult Medicine | | | No |
| 10 | 2084B0040X | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | | | Yes |
| 11 | 2084P0015X | Psychiatry & Neurology | Psychosomatic Medicine | | | No |
| 12 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 13 | 2084P2900X | Psychiatry & Neurology | Pain Medicine | | | No |
| 14 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 15 | 364SF0001X | Clinical Nurse Specialist | Family Health | | | No |