Healthcare Provider Details

I. General information

NPI: 1235547654
Provider Name (Legal Business Name): BRIAN SALAZAR-PRINCE M.ED., MSCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRIAN PRINCE MS, MED, MPH

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 N 3RD ST
PHOENIX AZ
85012-3002
US

IV. Provider business mailing address

1700 E BASELINE RD UNIT 43
PHOENIX AZ
85042-6768
US

V. Phone/Fax

Practice location:
  • Phone: 602-762-7329
  • Fax:
Mailing address:
  • Phone: 602-762-7329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4304852
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: