Basic Information
| Provider Information | |||||||||
| NPI: | 1750743688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST YAVAPAI GUIDANCE CLINIC INC | ||||||||
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| OtherOrganizationName: | POLARA HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3343 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863141213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284455211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3075 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863141208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284455211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2016 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | LANGLEY | ||||||||
| AuthorizedOfficialFirstName: | KARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9284455211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | BH4842 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.