Provider Demographics
| NPI: | 1326488073 |
|---|---|
| Name: | PREVAIL COUNSELING & FORENSIC MENTAL HEALTH CONSULTING, P.C. |
| Entity Type: | Organization |
| Organization Name: | PREVAIL COUNSELING & FORENSIC MENTAL HEALTH CONSULTING, P.C. |
| Other - Org Name: | PREVAIL BEHAVIORAL HEALTH & WELLNESS CENTER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | STEPHANIE |
| Authorized Official - Middle Name: | KOSUT |
| Authorized Official - Last Name: | GREGORY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | 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?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-06-26 |
| Last Update Date: | 2023-11-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 3770653-01 | Medicaid |
