Healthcare Provider Details

I. General information

NPI: 1073762258
Provider Name (Legal Business Name): WEST YAVAPAI GUIDANCE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-2283
US

IV. Provider business mailing address

3343 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1213
US

V. Phone/Fax

Practice location:
  • Phone: 928-583-6411
  • Fax: 928-775-9231
Mailing address:
  • Phone: 928-445-5211
  • Fax: 928-776-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberOTC6714
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBHSH-3202
License Number StateAZ

VIII. Authorized Official

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