Healthcare Provider Details

I. General information

NPI: 1235863242
Provider Name (Legal Business Name): PREVAIL COUNSELING AND FORENSIC MENTAL HEALTH,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LONGMIRE RD
CONROE TX
77304-1819
US

IV. Provider business mailing address

620 LONGMIRE RD
CONROE TX
77304-1819
US

V. Phone/Fax

Practice location:
  • Phone: 936-443-9629
  • Fax: 855-443-9630
Mailing address:
  • Phone: 936-443-9629
  • Fax: 855-443-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE J KOSUT
Title or Position: PRESIDENT OF COMPANY
Credential: MA,LPC-S
Phone: 936-443-9629