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 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | SATC221 | NEBRASKA | No |
| 2 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | SATC221 | NEBRASKA | No |
| 3 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | SATC221 | NEBRASKA | No |
| 4 | 261QM0850X | Clinic/Center | Adult Mental Health | SATC221 | NEBRASKA | No |
| 5 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | SATC221 | NEBRASKA | No |
| 6 | 101YM0800X | Counselor | Mental Health | SATC221 | NEBRASKA | No |
| 7 | 103TC0700X | Psychologist | Clinical | SATC221 | NEBRASKA | No |
| 8 | 207QA0401X | Family Medicine | Addiction Medicine | SATC221 | NEBRASKA | No |
| 9 | 261QM1300X | Clinic/Center | Multi-Specialty | SATC221 | NEBRASKA | 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 | =========98 | OTHER | NEBRASKA | NE MEDICAID ADULT DD IOP PROVIDER ID |
| 2 | 10026038302 | OTHER | NEBRASKA | NE MEDICAID DP PHARMACY PROVIDER ID |
| 3 | 2819196 | OTHER | NEBRASKA | NCPDP NPDS # |
| 4 | 99036 | OTHER | NEBRASKA | BCBS FACILITY MH |
| 5 | 99037 | OTHER | NEBRASKA | BCBS FACILITY SA |
| 6 | 098935 | OTHER | NEBRASKA | MEDICARE PTAN |
| 7 | 129619 | OTHER | NEBRASKA | VALUE OPTIONS FACILITY ID |
| 8 | 994768 | OTHER | NEBRASKA | COVENTRY FACILITY ID |
| 9 | CJ5965 | OTHER | NEBRASKA | MEDICARE RR UPIN |
| 10 | FAC001060700 | OTHER | NEBRASKA | OPTUM FACILITY ID |
| 11 | 10026038301 | OTHER | NEBRASKA | NE MEDICAID MEDICAL PROVIDER ID |
| 12 | =========30 | OTHER | NEBRASKA | NE MEDICAID MAIN PROVIDER ID |
| 13 | 10026038300 | OTHER | NEBRASKA | NE MEDICAID ADOLESCENT IOP PROVIDER ID |
| 14 | 28D2077900 | OTHER | NEBRASKA | CLIA WAIVER CERT. |
| 15 | 10025734000 | OTHER | NEBRASKA | NE MEDICAID ADULT SA PROVIDER ID |
| 16 | 9094585 | OTHER | NEBRASKA | AETNA FACILITY ID |
