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 | 103TB0200X | Psychologist | Cognitive & Behavioral | | | No |
| 3 | 103TC0700X | Psychologist | Clinical | | | No |
| 4 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 5 | 104100000X | Social Worker | | | MICHIGAN | No |
| 6 | 122300000X | Dentist | | | | No |
| 7 | 133V00000X | Dietitian, Registered | | | | No |
| 8 | 152W00000X | Optometrist | | | | No |
| 9 | 163W00000X | Registered Nurse | | | | No |
| 10 | 183500000X | Pharmacist | | 5301009686 | MICHIGAN | No |
| 11 | 207Q00000X | Family Medicine | | | | No |
| 12 | 207R00000X | Internal Medicine | | | MICHIGAN | No |
| 13 | 208000000X | Pediatrics | | | | No |
| 14 | 261QF0400X | Clinic/Center | Federally Qualified Health Center (FQHC) | | | Yes |
