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 | 363L00000X | Nurse Practitioner | | | | No |
| 2 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 3 | 103K00000X | Behavior Analyst | | | | No |
| 4 | 363A00000X | Physician Assistant | | | | No |
| 5 | 103TC0700X | Psychologist | Clinical | | | No |
| 6 | 207Q00000X | Family Medicine | | | | No |
| 7 | 207R00000X | Internal Medicine | | | | No |
| 8 | 208000000X | Pediatrics | | | | No |
| 9 | 101YM0800X | Counselor | Mental Health | | | No |
| 10 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | Yes |