Healthcare Provider Details

I. General information

NPI: 1376261651
Provider Name (Legal Business Name): GUIDANCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 E INDUSTRIAL DR
FLAGSTAFF AZ
86004-6109
US

IV. Provider business mailing address

2187 N VICKEY ST
FLAGSTAFF AZ
86004-6121
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-1899
  • Fax: 928-527-0028
Mailing address:
  • Phone: 928-527-1899
  • Fax: 928-527-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DEVON FORREST
Title or Position: CEO
Credential:
Phone: 928-527-1899