Provider Demographics
NPI:1952550071
Name:WEST YAVAPAI GUIDANCE CLINIC, INC
Entity type:Organization
Organization Name:WEST YAVAPAI GUIDANCE CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
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:86314-1213
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-776-8484
Practice Address - Street 1:181 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1705
Practice Address - Country:US
Practice Address - Phone:928-583-6411
Practice Address - Fax:928-772-5445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST YAVAPAI GUIDANCE CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH4435284300000X
AZSH-4435283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ366289Medicaid
AZ366289Medicaid