MEDICARE: PREVAIL COUNSELING FOR WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1790560696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVAIL COUNSELING FOR WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1500 FAWN DR
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-2303
Country	:	US
Telephone Number	:	319-343-7727
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 N MADISON AVE UNIT 3
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-8402
Country	:	US
Telephone Number	:	319-343-7727
Fax Number	:

Authorized Official
Title or Position	:	OWNER, MENTAL HEALTH COUNSELOR
Name	:	DAWN RECHKEMMER
Credential	:
Telephone Number	:	319-343-7727

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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