Provider Demographics
NPI:1104047398
Name:PRINCE, EVA MARIE
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:MARIE
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:PO BOX 87010
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754
Mailing Address - Country:US
Mailing Address - Phone:520-770-3865
Mailing Address - Fax:520-770-3861
Practice Address - Street 1:1200 W SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-770-3865
Practice Address - Fax:520-770-3861
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports