Healthcare Provider Details

I. General information

NPI: 1639367105
Provider Name (Legal Business Name): WEST YAVAPAI GUIDANCE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date: 08/08/2018
Reactivation Date: 09/21/2018

III. Provider practice location address

3343 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1213
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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberBH 309
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH 309
License Number StateAZ

VIII. Authorized Official

Name: LUIS GONZALEZ
Title or Position: CEO
Credential:
Phone: 928-445-5211