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 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | 32 0893 00 / 181 | WASHINGTON | No |
| 2 | 323P00000X | Psychiatric Residential Treatment Facility | | 32 0893 00 / 181 | WASHINGTON | No |
| 3 | 3245S0500X | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 32 0893 00 / 181 | WASHINGTON | No |
| 4 | 251B00000X | Case Management | | 32 0893 00 / 181 | WASHINGTON | No |
| 5 | 251C00000X | Day Training, Developmentally Disabled Services | | 32 0893 00 / 181 | WASHINGTON | No |
| 6 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | 32 0893 00 / 181 | WASHINGTON | No |
| 7 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | 32 0893 00 / 181 | WASHINGTON | No |
| 8 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | 32 0893 00 / 181 | WASHINGTON | No |
| 9 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | 32 0893 00 / 181 | WASHINGTON | 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 | 2015145 | MEDICAID | WASHINGTON | |
| 2 | 450639 | MEDICAID | WASHINGTON | |
| 3 | 1007885 | MEDICAID | WASHINGTON | |
| 4 | 1993435 | MEDICAID | WASHINGTON | |
