A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master?s degree and clinical experience and supervision for licensure or certification.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Counselor | 101Y00000X |
| Addiction (Substance Use Disorder) | 101YA0400X | |
| Mental Health | 101YM0800X | |
| Pastoral | 101YP1600X | |
| Professional | 101YP2500X |
* Indicates primary specialty
| NPI Number | 1063425122 |
| Credentials | PHD LPC LAC |
| Entity | Individual |
| Enumeration date | 08/13/2006 |
| Last updated | 06/15/2021 - About 5 years ago |
| Sole proprietor1 | Yes |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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