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 | 103TC0700X | Psychologist | Clinical | | | No |
| 3 | 163WP0809X | Registered Nurse | Psychiatric/Mental Health, Adult | | | No |
| 4 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 5 | 103T00000X | Psychologist | | | | No |
| 6 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 7 | 1041C0700X | Social Worker | Clinical | | | No |
| 8 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 9 | 364SP0809X | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | | | No |
| 10 | 106H00000X | Marriage & Family Therapist | | | | No |
| 11 | 207R00000X | Internal Medicine | | | | Yes |