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 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 2 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 3 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 4 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 5 | 251S00000X | Community/Behavioral Health | | | | No |
| 6 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 7 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 8 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 9 | 324500000X | Substance Abuse Rehabilitation Facility | | | | No |
| 10 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 11 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 12 | 3245S0500X | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | | | No |
| 13 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 14 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | Yes |