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 | 101Y00000X | Counselor | | | | No |
| 2 | 208D00000X | General Practice | | | | No |
| 3 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 4 | 171W00000X | Contractor | | | | No |
| 5 | 207RA0401X | Internal Medicine | Addiction Medicine | | | No |
| 6 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | | | No |
| 7 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 8 | 2084B0040X | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | | | No |
| 9 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 10 | 207QA0401X | Family Medicine | Addiction Medicine | | | Yes |