Basic Information
| Provider Information | |||||||||
| NPI: | 1285398990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREVAIL BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 937 BAY GROVE RD | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324394837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546322835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2050 W COUNTY HIGHWAY 30A | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324590187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546322835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MGR | ||||||||
| AuthorizedOfficialTelephone: | 9546322835 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.