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 | 101YM0800X | Counselor | Mental Health | | | No |
| 2 | 103K00000X | Behavior Analyst | | | | No |
| 3 | 103T00000X | Psychologist | | | | No |
| 4 | 1041C0700X | Social Worker | Clinical | | | No |
| 5 | 2084P0015X | Psychiatry & Neurology | Psychosomatic Medicine | | | No |
| 6 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 7 | 103TC0700X | Psychologist | Clinical | | | No |
| 8 | 164X00000X | Licensed Vocational Nurse | | | | No |
| 9 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 10 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 11 | 171M00000X | Case Manager/Care Coordinator | | | | No |
| 12 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | No |
| 13 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | | | No |
| 14 | 163WA2000X | Registered Nurse | Administrator | | | No |
| 15 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | Yes |
