Provider Demographics
NPI:1841163664
Name:WEST YAVAPAI GUIDANCE CLINIC INC
Entity type:Organization
Organization Name:WEST YAVAPAI GUIDANCE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-340-5262
Mailing Address - Street 1:3343 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1213
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-717-1204
Practice Address - Street 1:850 COVE PKWY STE A
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5446
Practice Address - Country:US
Practice Address - Phone:928-445-5211
Practice Address - Fax:928-717-1204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST YAVAPAI GUIDANCE CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty