Basic Information
| Provider Information | |||||||||
| NPI: | 1811065600 | ||||||||
| 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: | 860046106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285271899 | ||||||||
| FaxNumber: | 9284473779 | ||||||||
| Practice Location | |||||||||
| Address1: | 2695 E INDUSTRIAL DR | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287146450 | ||||||||
| FaxNumber: | 9285271319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FORREST | ||||||||
| AuthorizedOfficialFirstName: | DEVON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9285271899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 251S00000X | BH-2845 | AZ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 158133 | 05 | AZ | MEDICAID | BH-2845 | 01 | AZ | BEHAVIORAL HEALTH LICENSE | OTHER |