Provider Demographics
NPI:1376008433
Name:PREVAIL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PREVAIL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:901-295-9422
Mailing Address - Street 1:706 CARTER DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2403
Mailing Address - Country:US
Mailing Address - Phone:901-295-9422
Mailing Address - Fax:855-765-7701
Practice Address - Street 1:310 MID CONTINENT PLZ STE 404
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1700
Practice Address - Country:US
Practice Address - Phone:901-294-9522
Practice Address - Fax:855-765-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1811209745OtherMENTAL HEALTH THERAPIST