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 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 2 | 101YM0800X | Counselor | Mental Health | | | No |
| 3 | 101YP2500X | Counselor | Professional | | | No |
| 4 | 103TC0700X | Psychologist | Clinical | | | No |
| 5 | 1041C0700X | Social Worker | Clinical | | | No |
| 6 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | No |
| 7 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 8 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | Yes |
| 9 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 10 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 11 | 363A00000X | Physician Assistant | | | | No |
| 12 | 363AM0700X | Physician Assistant | Medical | | | No |
| 13 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |