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 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 2 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 3 | 101Y00000X | Counselor | | | | No |
| 4 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 5 | 104100000X | Social Worker | | | | No |
| 6 | 103K00000X | Behavior Analyst | | | | No |
| 7 | 103T00000X | Psychologist | | | | No |
| 8 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 9 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 10 | 106H00000X | Marriage & Family Therapist | | | | No |
| 11 | 106S00000X | Behavior Technician | | | | No |
| 12 | 1041C0700X | Social Worker | Clinical | | | Yes |