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 | 103TC1900X | Psychologist | Counseling | | | No |
| 2 | 122300000X | Dentist | | | | No |
| 3 | 124Q00000X | Dental Hygienist | | | | No |
| 4 | 133V00000X | Dietitian, Registered | | | | No |
| 5 | 163WC0400X | Registered Nurse | Case Management | | | No |
| 6 | 1835P1200X | Pharmacist | Pharmacotherapy | | | No |
| 7 | 207Q00000X | Family Medicine | | | | No |
| 8 | 207R00000X | Internal Medicine | | | TEXAS | No |
| 9 | 207RI0200X | Internal Medicine | Infectious Disease | | | No |
| 10 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 11 | 251B00000X | Case Management | | | | No |
| 12 | 261QC1500X | Clinic/Center | Community Health | | | No |
| 13 | 261QF0400X | Clinic/Center | Federally Qualified Health Center (FQHC) | | | Yes |
| 14 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 15 | 363LF0000X | Nurse Practitioner | Family | | | No |
