Provider Demographics
NPI:1477675023
Name:GUY, ALPHONSO N
Entity Type:Individual
Prefix:MR
First Name:ALPHONSO
Middle Name:N
Last Name:GUY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-1757
Mailing Address - Country:US
Mailing Address - Phone:928-755-1033
Mailing Address - Fax:928-755-1022
Practice Address - Street 1:JUNCTION STATE HIGHWAY 264 AND US HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-1757
Practice Address - Country:US
Practice Address - Phone:928-755-1033
Practice Address - Fax:928-755-1022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool