| Entity Name: | MARY L. MILLER, M.A., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Jun 1989 (36 years ago) |
| Document Number: | K93239 |
| FEI/EIN Number | 592958155 |
| Address: | 1101 W HIBISCUS BLVD, SUITE 104, MELBOURNE, FL, 32901, US |
| Mail Address: | P O BOX 1176, MELBOURNE, FL, 32902, US |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275514945 | 2005-11-09 | 2014-06-02 | PO BOX 1176, MELBOURNE, FL, 329021176, US | 1101 W HIBISCUS BLVD, SUITE 104, MELBOURNE, FL, 329012718, US | |||||||||||||||||||
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| Phone | +1 321-723-0070 |
| Fax | 3217236150 |
Authorized person
| Name | BARBARA YOUNG |
| Role | OFFICE MANAGER |
| Phone | 3217230070 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH1556 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MILLER MARY L | Agent | 650 DE SOTO LANE, INDIAN HARBOUR BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| MILLER MARY L | Director | 650 DESOTO LANE, INDIAN HARBOR BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| MILLER MARY L | President | 650 DESOTO LANE, INDIAN HARBOR BEACH, FL, 32937 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000007710 | MARTY MILLER, M.A., P.A. | ACTIVE | 2012-01-23 | 2027-12-31 | No data | POST OFFICE BOX 1176, MELBOURNE, FL, 32902 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1996-04-16 | MARY L. MILLER, M.A., P.A. | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
