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 | 251K00000X | Public Health or Welfare | | 1253-10266 | MISSOURI | 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 | CCCJS A11182 | OTHER | | AMERICAN COLLEGE OF CERTIFIED FORENSIC COUNSELORS |
| 2 | SATOP 066 | OTHER | MISSOURI | MO STATE CERTIFIED SUBSTANCE ABUSE TRAFFIC OFFENDER PROGRAMS |
| 3 | REACT R-319 | OTHER | MISSOURI | MO STATE CERTIFIED REQUIRED EDUCATIONAL ASSESSMENT AND COMMUNITY TREATMENT |
| 4 | CASAC 542 | OTHER | MISSOURI | MISSOURI SUBSTANCE ABUSE PROFESSIONAL CREDENTIALING BOARD |
| 5 | MAC 501662 | OTHER | | NATIONAL ASSOCIATION OF ALCOHOL & DRUG ABUSE COUNSELORS |
| 6 | 1253-10266 | OTHER | MISSOURI | MO STATE CERTIFIED INTENMSIVE OUTPATIENT ALCOHOL & DRUG REHABILITATION CLINIC |
| 7 | VENDOR 000613401 | OTHER | MISSOURI | MISSOURI DEPARTMENT OF SOCIAL SERVICES, CHILDRENS DIVISION |
| 8 | ICAADC 597 | OTHER | | THE INTERNATIONAL CERTIFICATION & RECIPROCITY CONSORTIUM / A & D ABUSE, INC. |
