Provider Demographics
NPI:1376896936
Name:PRINCE, RIEMOND ELDON III
Entity Type:Individual
Prefix:
First Name:RIEMOND
Middle Name:ELDON
Last Name:PRINCE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8583 CANDLEWOOD DR APT 571
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4460
Mailing Address - Country:US
Mailing Address - Phone:405-822-3299
Mailing Address - Fax:
Practice Address - Street 1:8583 CANDLEWOOD DR APT 571
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4460
Practice Address - Country:US
Practice Address - Phone:405-822-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health