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 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 2 | 364SA2100X | Clinical Nurse Specialist | Acute Care | | | No |
| 3 | 363AM0700X | Physician Assistant | Medical | | | No |
| 4 | 363L00000X | Nurse Practitioner | | | | No |
| 5 | 363LA2200X | Nurse Practitioner | Adult Health | | | No |
| 6 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 7 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 8 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 9 | 101YP2500X | Counselor | Professional | | | No |
| 10 | 103T00000X | Psychologist | | | | No |
| 11 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 12 | 103TC0700X | Psychologist | Clinical | | | No |
| 13 | 1041C0700X | Social Worker | Clinical | | | No |
| 14 | 207R00000X | Internal Medicine | | | | No |
| 15 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | Yes |