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 | 104100000X | Social Worker | | LCSW709 | TENNESSEE | 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 | 55538 | OTHER | | CIGNA MCC |
| 2 | 33476 | OTHER | | UBH SENIOR |
| 3 | 3920947 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | |
| 4 | 0128301 | OTHER | | MAGELLAN PINNACLE |
| 5 | 104224 | OTHER | | VALUEOPTIONS |
| 6 | 1046524 | OTHER | | FIRST HEALTH |
| 7 | 189387 FVJC | OTHER | | ANTHEM PREF TRIGON |
| 8 | 334969 | OTHER | | VALUEOPTIONS GROUP |
| 9 | 3920247 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | |
| 10 | 0128301 | OTHER | | MAGELLAN EAP |
| 11 | 0128301 | OTHER | | MAGELLAN SUMMIT |
| 12 | 33476 | OTHER | | UBH HEALTHPLAN |
| 13 | 0128301 | OTHER | | MAGELLAN NAVIGATOR |
| 14 | 189387 FVJC | OTHER | | ANTHEM PROF TRIGON |
| 15 | 33476 | OTHER | | UBH EMPLOYER |
