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 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 104100000X | Social Worker | | | | No |
| 4 | 163WA0400X | Registered Nurse | Addiction (Substance Use Disorder) | | | No |
| 5 | 163WP0807X | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | | | No |
| 6 | 163WP0809X | Registered Nurse | Psychiatric/Mental Health, Adult | | | No |
| 7 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 8 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 9 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 10 | 363L00000X | Nurse Practitioner | | | | No |
| 11 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 12 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | Yes |