Provider Demographics
NPI:1316212178
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:K
Authorized Official - Last Name:PLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-445-5211
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:86314-2283
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-776-8031
Practice Address - Street 1:3345 N WINDSONG DR
Practice Address - Street 2:ATTN: TINA TOLLIVER, SUITE B
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2283
Practice Address - Country:US
Practice Address - Phone:928-583-6411
Practice Address - Fax:928-776-8031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST YAVAPAI GUIDANCE CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 5318261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC 5318OtherADHS MEDICAL LICENSE