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 | 101Y00000X | Counselor | | 74 DOM VIOLENCE | KENTUCKY | No |
| 2 | 101Y00000X | Counselor | | 32 SEX OFFENDER COUN | KENTUCKY | No |
| 3 | 101Y00000X | Counselor | | 418 PRO GAMBL, ACGCC | KENTUCKY | Yes |
| 4 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | 0037 | KENTUCKY | No |
| 5 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | 8027 NADAC | KENTUCKY | No |
| 6 | 1041C0700X | Social Worker | Clinical | 290 | KENTUCKY | No |
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 | 418 | OTHER | KENTUCKY | NATIONAL, COMP GAMBLING |
| 2 | 290 | OTHER | KENTUCKY | LCSW |
| 3 | 74 | OTHER | KENTUCKY | DOMESTIC VIOLENCE COUNSEL |
| 4 | 32 | OTHER | KENTUCKY | SEX OFFENDER COUNSELOR |
| 5 | OO37 | OTHER | KENTUCKY | CADC, CHEMICAL DEP |
| 6 | 8207 | OTHER | KENTUCKY | NADAC CHEM DEP, NATION |
| 7 | 90208 | OTHER | KENTUCKY | NATIONAL- NADAC |
