Healthcare Provider Details

I. General information

NPI: 1912006024
Provider Name (Legal Business Name): WILLIAM C. PRINCE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S DON ROSER DR
LAS CRUCES NM
88011
US

IV. Provider business mailing address

150 THE PROMENADE N UNIT 515
LONG BEACH CA
90802-4757
US

V. Phone/Fax

Practice location:
  • Phone: 323-804-3590
  • Fax:
Mailing address:
  • Phone: 323-804-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22883
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1675
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-2025-0107
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: