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 | 101YP2500X | Counselor | Professional | | | No |
| 2 | 103K00000X | Behavior Analyst | | | | No |
| 3 | 103T00000X | Psychologist | | | | No |
| 4 | 1041C0700X | Social Worker | Clinical | | | No |
| 5 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 6 | 251S00000X | Community/Behavioral Health | | | | Yes |
| 7 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 8 | 283Q00000X | Psychiatric Hospital | | | | No |
| 9 | 284300000X | Special Hospital | | SH1852 | ARIZONA | No |
| 10 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
| 11 | 324500000X | Substance Abuse Rehabilitation Facility | | | | No |
| 12 | 343900000X | Non-emergency Medical Transport (VAN) | | | | No |
| 13 | 363A00000X | Physician Assistant | | | | No |
| 14 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 15 | 363LP2300X | Nurse Practitioner | Primary Care | | | 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 | 969884 | MEDICAID | ARIZONA | |
| 2 | 085095 | MEDICAID | ARIZONA | |
| 3 | 154902 | MEDICAID | ARIZONA | |
| 4 | 158133 | MEDICAID | ARIZONA | |
| 5 | 598089 | MEDICAID | ARIZONA | |
| 6 | 106944 | MEDICAID | ARIZONA | |
| 7 | 855908 | MEDICAID | ARIZONA | |