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General NPI Number Information
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NPI Number | 1235863242
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Entity Type | Organization
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Legal Business Name | PREVAIL COUNSELING AND FORENSIC MENTAL HEALTH,
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 620 LONGMIRE RD
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City | CONROE
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State | TX
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Zip | 77304-1819
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Country | US
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Telephone | 936-443-9629
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Fax | 855-443-9630
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Provider Business Mailing Address
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Address Line | 620 LONGMIRE RD
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City | CONROE
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State | TX
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Zip | 77304-1819
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Country | US
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Telephone | 936-443-9629
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Fax | 855-443-9630
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Authorized Official
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Title or Position | PRESIDENT OF COMPANY
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Name | MS. STEPHANIE J KOSUT
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Credential | MA,LPC-S
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Telephone | 936-443-9629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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