Provider Demographics
NPI:1174221717
Name:PRINCE, KRYSTIN
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S FAHRION PL APT E
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4270
Mailing Address - Country:US
Mailing Address - Phone:424-245-9466
Mailing Address - Fax:
Practice Address - Street 1:1365 OHIO AVE APT 304
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2450
Practice Address - Country:US
Practice Address - Phone:909-663-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst