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 | 251S00000X | Community/Behavioral Health | | | | No |
| 2 | 261Q00000X | Clinic/Center | | | | No |
| 3 | 251B00000X | Case Management | | | | 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 | 100006624 0021 | OTHER | PENNSYLVANIA | D AND A MH SUBSTANCE ABUSE |
| 2 | 100006624 | OTHER | PENNSYLVANIA | MEDICAL ASSISTANCE ID |
| 3 | 100006624 0003 | OTHER | PENNSYLVANIA | BERKS CRISIS |
| 4 | 1000066240092 | OTHER | PENNSYLVANIA | ALLEGHENY ID 400 PENN CENTER BOULEVARD SUITE 410 PITTSBURGH PA 15235 |
| 5 | 100006624 0025 | OTHER | PENNSYLVANIA | HMJ TSM LEWISTOWN MIFFLIN COUNTY |
| 6 | 1000491 | OTHER | PENNSYLVANIA | CCBH ID |
| 7 | 100006624 0026 | OTHER | PENNSYLVANIA | HMJ TSM MIFFLINTOWN JUNIATA COUNTY |
| 8 | 100006624 0025 | OTHER | PENNSYLVANIA | HMJ TSM HUNTNGDON-HUNTINGDON COUNTY |
| 9 | 100006624 0042 | OTHER | PENNSYLVANIA | CLARION OP |