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 | 208D00000X | General Practice | | | | No |
| 2 | 101Y00000X | Counselor | | | | No |
| 3 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 4 | 101YM0800X | Counselor | Mental Health | | | No |
| 5 | 101YP2500X | Counselor | Professional | | | No |
| 6 | 103T00000X | Psychologist | | | | No |
| 7 | 104100000X | Social Worker | | | | No |
| 8 | 207R00000X | Internal Medicine | | | | No |
| 9 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 10 | 363L00000X | Nurse Practitioner | | | | No |
| 11 | 364SC2300X | Clinical Nurse Specialist | Chronic Care | | | No |
| 12 | 207Q00000X | Family Medicine | | | | Yes |