| Entity Name: | MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Feb 2005 (20 years ago) |
| Document Number: | L05000020939 |
| FEI/EIN Number | 261873776 |
| Address: | 1421 SE 4th Avenue, 1st Floor, Fort Lauderdale, FL, 33316, US |
| Mail Address: | 1421 SE 4th Avenue, 1st Floor, Fort Lauderdale, FL, 33316, US |
| ZIP code: | 33316 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134598162 | 2015-09-21 | 2015-09-21 | 2425 E COMMERCIAL BLVD, SUITE 301, FORT LAUDERDALE, FL, 333084034, US | 2425 E COMMERCIAL BLVD, SUITE 301, FORT LAUDERDALE, FL, 333084034, US | |||||||||||||||||||
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| Phone | +1 954-606-5088 |
| Fax | 9546165147 |
Authorized person
| Name | DR. MARCY JASLOW |
| Role | LICENSED PSYCHOLOGIST |
| Phone | 9546165088 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY9326 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC 401(K) PLAN | 2023 | 261873776 | 2024-05-15 | MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC | 12 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-15 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621330 |
| Sponsor’s telephone number | 9546165088 |
| Plan sponsor’s address | 3600 N. OCEAN BLVD., FLOOR 2, FORT LAUDERDALE, FL, 33308 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-27 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621330 |
| Sponsor’s telephone number | 9546165088 |
| Plan sponsor’s address | 3600 N. OCEAN BLVD., FLOOR 2, FORT LAUDERDALE, FL, 33308 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2022-05-31 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| EICKLEBERRY LORI L | Agent | 441 Royal Plaza Dr, FT LAUDERDALE, FL, 33301 |
| Name | Role | Address |
|---|---|---|
| Eickleberry Lori PhD | Managing Member | 1421 SE 4th Avenue, Fort Lauderdale, FL, 33316 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-27 | 1421 SE 4th Avenue, 1st Floor, Fort Lauderdale, FL 33316 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-27 | 1421 SE 4th Avenue, 1st Floor, Fort Lauderdale, FL 33316 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-30 | 441 Royal Plaza Dr, FT LAUDERDALE, FL 33301 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-03-04 | EICKLEBERRY, LORI LPHD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-03-22 |
| ANNUAL REPORT | 2017-02-17 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
