Healthcare Provider Details

I. General information

NPI: 1942651807
Provider Name (Legal Business Name): JASON DUENAS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
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: 352-246-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75825
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: