Provider Demographics
NPI:1235863242
Name:PREVAIL COUNSELING AND FORENSIC MENTAL HEALTH,
Entity Type:Organization
Organization Name:PREVAIL COUNSELING AND FORENSIC MENTAL HEALTH,
Other - Org Name:PREVAIL COUNSELING & FORENSIC MENTAL HEALTH,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSUT
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC-S
Authorized Official - Phone:936-443-9629
Mailing Address - Street 1:620 LONGMIRE RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1819
Mailing Address - Country:US
Mailing Address - Phone:936-443-9629
Mailing Address - Fax:855-443-9630
Practice Address - Street 1:620 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1819
Practice Address - Country:US
Practice Address - Phone:936-443-9629
Practice Address - Fax:855-443-9630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVAIL COUNSELING & FORENSIC MENTAL HEALTH,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty