MEDICARE: WEST YAVAPAI GUIDANCE CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	261Q00000X	Clinic/Center	OTC6375	AZ

General Provider Information

NPI Number	:	1417901943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST YAVAPAI GUIDANCE CLINIC, INC.

Provider Business Mailing Address
First Line	:	3343 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1213
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:	928-776-8484

Provider Business Practice Location Address
First Line	:	3345 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2283
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:	928-776-8484

Authorized Official
Title or Position	:	CEO
Name	:	TAMARA PLAYER
Credential	:
Telephone Number	:	928-445-5211

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/26/2026

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