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 | 207Q00000X | Family Medicine | | | | No |
| 2 | 2083A0300X | Preventive Medicine | Addiction Medicine | | | No |
| 3 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | | | No |
| 4 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 5 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | | | No |
| 6 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | | | No |
| 7 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 8 | 101Y00000X | Counselor | | | | No |
| 9 | 103TC2200X | Psychologist | Clinical Child & Adolescent | | | No |
| 10 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 11 | 1041C0700X | Social Worker | Clinical | | | No |
| 12 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | | | No |
| 13 | 106H00000X | Marriage & Family Therapist | | | | No |
| 14 | 103TC0700X | Psychologist | Clinical | | | No |
| 15 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | | | Yes |