Basic Information
| Provider Information | |||||||||
| NPI: | 1346433273 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE GUIDANCE CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BHRF-VSO | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285271899 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285271899 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | FORREST | ||||||||
| AuthorizedOfficialFirstName: | DEVON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9285271899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BHRF-VSO | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | BH4886 | 01 | AZ | ADHS LINCENSE | OTHER | 154902 | 05 | AZ | MEDICAID |