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 | 261QH0100X | Clinic/Center | Health Service | | | No |
| 2 | 261QR0401X | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | | | No |
| 3 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 4 | 2080P0006X | Pediatrics | Developmental - Behavioral Pediatrics | | | No |
| 5 | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | | | | No |
| 6 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | Yes |