Provider Demographics
NPI:1124720990
Name:PRINE, ERIN MCKENZIE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MCKENZIE
Last Name:PRINE
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 1:401 1/2 TAMMY LYNN DR APT B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1261
Mailing Address - Country:US
Mailing Address - Phone:903-931-9536
Mailing Address - Fax:
Practice Address - Street 1:401 1/2 TAMMY LYNN DR APT B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1261
Practice Address - Country:US
Practice Address - Phone:903-931-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst