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General NPI Number Information
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NPI Number | 1548407877
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Entity Type | Individual
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Provider Name | HERBERT CALVIN PRINCE III MSHR
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Gender | Female
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 23929 COUNTY ROAD 1560
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City | STONEWALL
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State | OK
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Zip | 74871-6472
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Country | US
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Telephone | 405-310-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 CRADDUCK RD
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City | ADA
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State | OK
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Zip | 74820-9491
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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