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 | 103T00000X | Psychologist | | | | No |
| 3 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 4 | 103TC1900X | Psychologist | Counseling | | | No |
| 5 | 103TH0004X | Psychologist | Health | | | No |
| 6 | 103TP2701X | Psychologist | Group Psychotherapy | | | Yes |
| 7 | 207R00000X | Internal Medicine | | | | No |
| 8 | 2084B0040X | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | | | No |
| 9 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 10 | 225100000X | Physical Therapist | | | | No |
| 11 | 2255A2300X | Specialist/Technologist | Athletic Trainer | | | No |
| 12 | 225700000X | Massage Therapist | | | | No |
| 13 | 225X00000X | Occupational Therapist | | | | No |
| 14 | 363L00000X | Nurse Practitioner | | | | No |
| 15 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |