MEDICARE: WEST YAVAPAI GUIDANCE CLINIC, INC

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	284300000X	Special Hospital	SH4435	AZ
2	283Q00000X	Psychiatric Hospital	SH-4435	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	:	1952550071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST YAVAPAI GUIDANCE CLINIC, INC

Provider Business Mailing Address
First Line	:	3343 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1213
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:	928-776-8484

Provider Business Practice Location Address
First Line	:	181 WHIPPLE ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1705
Country	:	US
Telephone Number	:	928-583-6411
Fax Number	:	928-772-5445

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TAMARA PLAYER
Credential	:
Telephone Number	:	928-445-5211

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	07/31/2023

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