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 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 3 | 207LP2900X | Anesthesiology | Pain Medicine | | | No |
| 4 | 207T00000X | Neurological Surgery | | | | No |
| 5 | 2084A2900X | Psychiatry & Neurology | Neurocritical Care | | | No |
| 6 | 2084D0003X | Psychiatry & Neurology | Diagnostic Neuroimaging | | | No |
| 7 | 2084F0202X | Psychiatry & Neurology | Forensic Psychiatry | | | No |
| 8 | 2084N0008X | Psychiatry & Neurology | Neuromuscular Medicine | | | No |
| 9 | 2084N0400X | Psychiatry & Neurology | Neurology | | | Yes |
| 10 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | | | No |
| 11 | 2084N0600X | Psychiatry & Neurology | Clinical Neurophysiology | | | No |
| 12 | 2084P0005X | Psychiatry & Neurology | Neurodevelopmental Disabilities | | | No |
| 13 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 14 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | No |
| 15 | 2084P2900X | Psychiatry & Neurology | Pain Medicine | | | No |
