Healthcare Provider Details

I. General information

NPI: 1073499331
Provider Name (Legal Business Name): COLLABORATIVE CHANGES COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4648 SW 57TH CT
GAINESVILLE FL
32608-0178
US

IV. Provider business mailing address

4648 SW 57TH CT
GAINESVILLE FL
32608-0178
US

V. Phone/Fax

Practice location:
  • Phone: 281-628-4194
  • Fax:
Mailing address:
  • Phone: 281-628-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JASON DUENAS
Title or Position: OWNER
Credential: LPC-S, LMHC, LCMHC
Phone: 281-628-4194