Healthcare Provider Details

I. General information

NPI: 1366034811
Provider Name (Legal Business Name): PREVAIL COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S OREM BLVD UNIT A
OREM UT
84058-5011
US

IV. Provider business mailing address

907 S OREM BLVD UNIT A
OREM UT
84058-5011
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-9204
  • Fax:
Mailing address:
  • Phone: 801-717-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY J. BENTLEY
Title or Position: OWNER
Credential: PSYD
Phone: 801-718-5315