Provider Demographics
NPI:1962014779
Name:DAN W PRINE PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:DAN W PRINE PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PRINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:209-535-6617
Mailing Address - Street 1:430 CRANE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4552
Mailing Address - Country:US
Mailing Address - Phone:209-535-6617
Mailing Address - Fax:
Practice Address - Street 1:430 CRANE AVE STE 109
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4552
Practice Address - Country:US
Practice Address - Phone:209-535-6617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)