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1073762258 NPI number — WEST YAVAPAI GUIDANCE CLINIC, INC.

NPI Number: 1073762258
Health Care Provider/Practitioner: WEST YAVAPAI GUIDANCE CLINIC, INC.

Information about “1073762258” NPI (WEST YAVAPAI GUIDANCE CLINIC, INC.) exists in 1073762258 in HTML format HTML  |  1073762258 in plain Text format TXT  |  1073762258 in PDF (Portable Document Format) PDF  |  1073762258 in an XML format XML  formats.

NPI Number : 1073762258 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073762258",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "WEST YAVAPAI GUIDANCE CLINIC, INC.",
    "ParentOrgTIN": null,
    "OrgName": "WEST YAVAPAI GUIDANCE CLINIC, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3343 N. WINDSONG DR.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PRESCOTT VALLEY",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86314-2283",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "928-445-5211",
    "MailingAddressFaxNumber": "928-776-8484",
    "FirstLinePracticeLocationAddress": "3347 N WINDSONG DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PRESCOTT VALLEY",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86314-2283",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "928-583-6411",
    "PracticeLocationAddressFaxNumber": "928-775-9231",
    "EnumerationDate": "09/12/2008",
    "LastUpdateDate": "06/14/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PLAYER",
    "AuthorizedOfficialFirstName": "TAMARA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "928-445-5211",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "BHSH-3202",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": "OTC6714",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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