Healthcare Provider Details

I. General information

NPI: 1316014459
Provider Name (Legal Business Name): GUIDANCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W GRANT AVE
WILLIAMS AZ
86046-2535
US

IV. Provider business mailing address

2187 N VICKEY ST
FLAGSTAFF AZ
86004-6121
US

V. Phone/Fax

Practice location:
  • Phone: 928-635-4272
  • Fax:
Mailing address:
  • Phone: 928-527-1899
  • Fax: 928-447-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC6139
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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