Provider Demographics
NPI:1891443792
Name:KUGEL, JASON E (MS, LMHC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:E
Last Name:KUGEL
Suffix:
Gender:M
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76466 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-1603
Mailing Address - Country:US
Mailing Address - Phone:904-548-7243
Mailing Address - Fax:
Practice Address - Street 1:76466 DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-1603
Practice Address - Country:US
Practice Address - Phone:904-548-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health