MEDICARE: WEST YAVAPAI GUIDANCE CLINIC CORTEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	BH178	AZ
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	OTC6686	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871547430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST YAVAPAI GUIDANCE CLINIC CORTEZ

Provider Business Mailing Address
First Line	:	3343 N. WINDSONG DR.
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2283
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:	928-776-8484

Provider Business Practice Location Address
First Line	:	505 S CORTEZ ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-4319
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:	928-776-8484

Authorized Official
Title or Position	:	CAO
Name	:	KARA LANGLEY
Credential	:
Telephone Number	:	928-445-5211

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/19/2024

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Directions to “WEST YAVAPAI GUIDANCE CLINIC CORTEZ ” Practice Location

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