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 | 103T00000X | Psychologist | | | | No |
| 2 | 103TC0700X | Psychologist | Clinical | | | No |
| 3 | 1041C0700X | Social Worker | Clinical | | | No |
| 4 | 164W00000X | Licensed Practical Nurse | | | | No |
| 5 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 6 | 225X00000X | Occupational Therapist | | | | No |
| 7 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 8 | 101YM0800X | Counselor | Mental Health | | | No |
| 9 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 10 | 364SP0813X | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric | | | No |
| 11 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | Yes |