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 | 101YP2500X | Counselor | Professional | | | No |
| 2 | 164W00000X | Licensed Practical Nurse | | | | No |
| 3 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 4 | 163W00000X | Registered Nurse | | | | No |
| 5 | 225100000X | Physical Therapist | | | | No |
| 6 | 103TP0016X | Psychologist | Prescribing (Medical) | | | No |
| 7 | 1041C0700X | Social Worker | Clinical | | | No |
| 8 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 9 | 103TC0700X | Psychologist | Clinical | | | No |
| 10 | 171400000X | Health and Wellness Coach | | | | No |
| 11 | 171M00000X | Case Manager/Care Coordinator | | | | No |
| 12 | 363A00000X | Physician Assistant | | | | No |
| 13 | 225X00000X | Occupational Therapist | | | | No |
| 14 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 15 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | Yes |
