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 | 103K00000X | Behavior Analyst | | | | No |
| 2 | 251B00000X | Case Management | | | MONTANA | No |
| 3 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 4 | 251S00000X | Community/Behavioral Health | | | | Yes |
| 5 | 253Z00000X | In Home Supportive Care | | | | No |
| 6 | 261Q00000X | Clinic/Center | | | | No |
| 7 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 8 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 9 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 10 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 11 | 310400000X | Assisted Living Facility | | | | No |
| 12 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 13 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
| 14 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | | | No |
| 15 | 343900000X | Non-emergency Medical Transport (VAN) | | | | No |
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 | 0350812 | MEDICAID | MONTANA | |
| 2 | 000744813 | OTHER | MONTANA | BCBS PRE-LIC'D PROFESSNLS |
| 3 | 0493119 | MEDICAID | MONTANA | |
| 4 | NM600001 | OTHER | NEW MEXICO | VALUEOPTIONS VENDOR ID |
| 5 | 0502299 | MEDICAID | MONTANA | |
| 6 | 0047124 | MEDICAID | MONTANA | |
| 7 | 0255374 | MEDICAID | MONTANA | |
| 8 | 0290343 | MEDICAID | MONTANA | |
| 9 | 0320255 | MEDICAID | MONTANA | |
| 10 | 0320331 | MEDICAID | MONTANA | |
| 11 | 690812 | MEDICAID | MONTANA | |
| 12 | 92507255 | MEDICAID | NEW MEXICO | |
| 13 | B3373 | MEDICAID | NEW MEXICO | |
