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 | 103TC0700X | Psychologist | Clinical | | | No |
| 2 | 103TC1900X | Psychologist | Counseling | | | No |
| 3 | 104100000X | Social Worker | | | | No |
| 4 | 1041C0700X | Social Worker | Clinical | | | No |
| 5 | 106H00000X | Marriage & Family Therapist | | | | No |
| 6 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | No |
| 7 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 8 | 363A00000X | Physician Assistant | | | | No |
| 9 | 101YP2500X | Counselor | Professional | | | No |
| 10 | 103T00000X | Psychologist | | | | No |
| 11 | 363LA2200X | Nurse Practitioner | Adult Health | | | No |
| 12 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 13 | 364SA2100X | Clinical Nurse Specialist | Acute Care | | | No |
| 14 | 363AM0700X | Physician Assistant | Medical | | | No |
| 15 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | Yes |
