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 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 2 | 103TC0700X | Psychologist | Clinical | | | No |
| 3 | 103TC1900X | Psychologist | Counseling | | | No |
| 4 | 103TF0000X | Psychologist | Family | | | No |
| 5 | 103TF0200X | Psychologist | Forensic | | | No |
| 6 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | | | No |
| 7 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 8 | 1041C0700X | Social Worker | Clinical | | | No |
| 9 | 224Z00000X | Occupational Therapy Assistant | | | | No |
| 10 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 11 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 12 | 261QM1300X | Clinic/Center | Multi-Specialty | | | Yes |
