Healthcare Provider Details

I. General information

NPI: 1285398990
Provider Name (Legal Business Name): PREVAIL BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAY GROVE BLVD
FREEPORT FL
32439-1725
US

IV. Provider business mailing address

937 BAY GROVE RD
FREEPORT FL
32439-4837
US

V. Phone/Fax

Practice location:
  • Phone: 954-632-2835
  • Fax: 850-273-6675
Mailing address:
  • Phone: 954-632-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MCDONALD
Title or Position: MGR
Credential:
Phone: 954-632-2835