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 | 261QP0905X | Clinic/Center | Public Health, State or Local | | | No |
| 2 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 3 | 261QM2800X | Clinic/Center | Methadone | | | No |
| 4 | 261QM1300X | Clinic/Center | Multi-Specialty | | | No |
| 5 | 207QA0401X | Family Medicine | Addiction Medicine | | | No |
| 6 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | | | No |
| 7 | 261QR1100X | Clinic/Center | Research | | | No |
| 8 | 251S00000X | Community/Behavioral Health | | | | No |
| 9 | 174400000X | Specialist | | | | No |
| 10 | 208D00000X | General Practice | | | | No |
| 11 | 225800000X | Recreation Therapist | | | | No |
| 12 | 251K00000X | Public Health or Welfare | | | | Yes |