Provider Demographics
NPI:1134649924
Name:WEST YAVAPAI GUIDANCE CLINIC INC
Entity Type:Organization
Organization Name:WEST YAVAPAI GUIDANCE CLINIC INC
Other - Org Name:POLARA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-455-5211
Mailing Address - Street 1:3343 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1213
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:
Practice Address - Street 1:8655 E EASTRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8561
Practice Address - Country:US
Practice Address - Phone:928-445-5211
Practice Address - Fax:928-772-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health