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 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 2 | 101YM0800X | Counselor | Mental Health | | | No |
| 3 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 4 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 5 | 133V00000X | Dietitian, Registered | | | | No |
| 6 | 163WP0809X | Registered Nurse | Psychiatric/Mental Health, Adult | | | No |
| 7 | 207SG0201X | Medical Genetics | Clinical Genetics (M.D.) | | | No |
| 8 | 207SM0001X | Medical Genetics | Molecular Genetic Pathology | | | No |
| 9 | 251B00000X | Case Management | | | | No |
| 10 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 11 | 171M00000X | Case Manager/Care Coordinator | | | | No |
| 12 | 251S00000X | Community/Behavioral Health | | | | Yes |
| 13 | 106S00000X | Behavior Technician | | | | No |
| 14 | 171400000X | Health and Wellness Coach | | | | No |
| 15 | 175T00000X | Peer Specialist | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1346368396 | MEDICAID | COLORADO | |
| 2 | 1831649367 | MEDICAID | COLORADO | |
| 3 | 1871177832 | MEDICAID | COLORADO | |
| 4 | 1306329412 | MEDICAID | COLORADO | |
| 5 | 1336619899 | MEDICAID | COLORADO | |
| 6 | 1699005009 | MEDICAID | COLORADO | |
| 7 | 1528641669 | MEDICAID | COLORADO | |
| 8 | 1053545897 | MEDICAID | COLORADO | |
| 9 | 1912580101 | MEDICAID | COLORADO | |
| 10 | 1578198271 | MEDICAID | COLORADO | |
| 11 | 1033757042 | MEDICAID | COLORADO | |
| 12 | 1326506452 | MEDICAID | COLORADO | |