Basic Information
| Provider Information | |||||||||
| NPI: | 1457785776 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GUIDANCE CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE GUIDANCE CENTER, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285271899 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285271899 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FORREST | ||||||||
| AuthorizedOfficialFirstName: | DEVON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9285271899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 104100000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 283Q00000X | N | Hospitals | Psychiatric Hospital | 284300000X | SH1852 | AZ | N | Hospitals | Special Hospital | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 106944 | 05 | AZ | MEDICAID | 116807 | 05 | AZ | MEDICAID | 154902 | 05 | AZ | MEDICAID | 855908 | 05 | AZ | MEDICAID | 085095 | 05 | AZ | MEDICAID | 969884 | 05 | AZ | MEDICAID | 158133 | 05 | AZ | MEDICAID | 598089 | 05 | AZ | MEDICAID |