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 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | PSB 94022177 | CALIFORNIA | No |
| 2 | 101YM0800X | Counselor | Mental Health | PSB 94022177 | CALIFORNIA | No |
| 3 | 103TA0700X | Psychologist | Adult Development & Aging | PSB 94022177 | CALIFORNIA | No |
| 4 | 103TB0200X | Psychologist | Cognitive & Behavioral | PSB 94022177 | CALIFORNIA | No |
| 5 | 103TC1900X | Psychologist | Counseling | PSB 94022177 | CALIFORNIA | No |
| 6 | 103TC2200X | Psychologist | Clinical Child & Adolescent | PSB 94022177 | CALIFORNIA | No |
| 7 | 103TF0000X | Psychologist | Family | PSB 94022177 | CALIFORNIA | No |
| 8 | 103TP2701X | Psychologist | Group Psychotherapy | PSB 94022177 | CALIFORNIA | No |
| 9 | 103TC0700X | Psychologist | Clinical | PSB 94022177 | CALIFORNIA | Yes |
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 | PSB 94022177 | OTHER | CALIFORNIA | BOARD OF PSYCHOLOGY |
