| Erica D. Prince, Phd, Llc | |
|
2945 Nw Mulkey Ave Corvallis OR 97330-1836 | |
| (541) 753-8684 | |
| (541) 752-0906 |
| Full Name | Erica D. Prince, Phd, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2945 Nw Mulkey Ave, Corvallis, Oregon |
| Authorized Official Name and Position | Erica D Prince (CHAIRMAN) |
| Authorized Official Contact | 5417538684 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Erica D. Prince, Phd, Llc 2945 Nw Mulkey Ave Corvallis OR 97330-1836 Ph: (541) 753-8684 | Erica D. Prince, Phd, Llc 2945 Nw Mulkey Ave Corvallis OR 97330-1836 Ph: (541) 753-8684 |
| NPI Number | 1033749825 |
|---|---|
| Provider Enumeration Date | 01/21/2020 |
| Last Update Date | 01/21/2020 |
| Certification Date | 01/21/2020 |
| Medicare PECOS PAC ID | 6305256462 |
|---|---|
| Medicare Enrollment ID | O20201102001448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033749825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Erica D Prince |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992885701 PECOS PAC ID: 1557408457 Enrollment ID: I20091026000676 |
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