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 | 261QM1300X | Clinic/Center | Multi-Specialty | | | No |
| 2 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 3 | 363A00000X | Physician Assistant | | | | No |
| 4 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 5 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 6 | 207QA0401X | Family Medicine | Addiction Medicine | | | No |
| 7 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 8 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 9 | 101YP2500X | Counselor | Professional | | | No |
| 10 | 1041C0700X | Social Worker | Clinical | | | No |
| 11 | 106H00000X | Marriage & Family Therapist | | | | No |
| 12 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | Yes |