Healthcare Provider Details

I. General information

NPI: 1538878186
Provider Name (Legal Business Name): WEST YAVAPAI GUIDANCE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 S MAIN ST STE 3
CAMP VERDE AZ
86322-7383
US

IV. Provider business mailing address

3343 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1213
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-5211
  • Fax: 928-776-8484
Mailing address:
  • Phone: 928-445-5211
  • Fax: 928-776-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TAMARA L PLAYER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-445-5211