Provider Demographics
| NPI: | 1457785776 |
|---|---|
| Name: | GUIDANCE CENTER INC |
| Entity type: | Organization |
| Organization Name: | GUIDANCE CENTER INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | DEVON |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | FORREST |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 928-527-1899 |
| Mailing Address - Street 1: | 2187 N VICKEY ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FLAGSTAFF |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 86004-6121 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 928-527-1899 |
| Mailing Address - Fax: | 928-714-6480 |
| Practice Address - Street 1: | 2187 N VICKEY ST |
| Practice Address - Street 2: | |
| Practice Address - City: | FLAGSTAFF |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 86004-6121 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 928-527-1899 |
| Practice Address - Fax: | 928-714-6480 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-08-22 |
| Last Update Date: | 2025-03-31 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YP2500X, 103K00000X, 103T00000X, 1041C0700X, 2084P0804X, 261QP2300X, 283Q00000X, 320800000X, 324500000X, 343900000X, 363A00000X, 363LP0808X, 363LP2300X, 251S00000X | ||
| AZ | SH1852 | 284300000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
| No | 283Q00000X | Hospitals | Psychiatric Hospital | Group - Multi-Specialty | |
| No | 284300000X | Hospitals | Special Hospital | Group - Multi-Specialty | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Multi-Specialty | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | ||
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 969884 | Medicaid | |
| AZ | 085095 | Medicaid | |
| AZ | 154902 | Medicaid | |
| AZ | 158133 | Medicaid | |
| AZ | 598089 | Medicaid | |
| AZ | 106944 | Medicaid | |
| AZ | 855908 | Medicaid | |
| AZ | 598089 | Medicaid |
