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 | 101YP2500X | Counselor | Professional | | | No |
| 3 | 163WC0400X | Registered Nurse | Case Management | | | No |
| 4 | 164X00000X | Licensed Vocational Nurse | | | | No |
| 5 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 6 | 251B00000X | Case Management | | | | No |
| 7 | 251S00000X | Community/Behavioral Health | | | | No |
| 8 | 251X00000X | Supports Brokerage | | | | No |
| 9 | 3104A0630X | Assisted Living Facility | Assisted Living, Behavioral Disturbances | | | No |
| 10 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 11 | 374K00000X | Religious Nonmedical Practitioner | | | | No |
| 12 | 171M00000X | Case Manager/Care Coordinator | | | | 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 | 285790 | OTHER | CALIFORNIA | BVN AND PSYCHIATRIC TECHNICIANS |
| 2 | 247207212 | OTHER | CALIFORNIA | FACILITY |
| 3 | 768074 | OTHER | CALIFORNIA | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
| 4 | 65927 | OTHER | CALIFORNIA | BBS/LICENSED CLINICAL SOCIAL WORKER |
| 5 | 851729 | OTHER | CALIFORNIA | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
| 6 | 289669 | OTHER | CALIFORNIA | BVN AND PSYCHIATRIC TECHNICIANS |
| 7 | C3791162 | OTHER | CALIFORNIA | SECRETARY OF STATE |
| 8 | C4564277 | OTHER | CALIFORNIA | SECRETARY OF STATE |
| 9 | 813953 | OTHER | CALIFORNIA | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
| 10 | 279040 | OTHER | CALIFORNIA | B VN AND PSYCHIATRIC TECHNICIANS |