Provider Demographics
NPI:1548407877
Name:PRINCE, HERBERT CALVIN III (MSHR)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:CALVIN
Last Name:PRINCE
Suffix:III
Gender:F
Credentials:MSHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CRADDUCK RD
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-9491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23929 COUNTY ROAD 1560
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:OK
Practice Address - Zip Code:74871-6472
Practice Address - Country:US
Practice Address - Phone:405-310-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor