| Entity Name: | TRACY RILEY COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jan 2009 (16 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 25 Sep 2017 (7 years ago) |
| Document Number: | L09000007919 |
| FEI/EIN Number | 26-4106342 |
| Address: | 11555 Central Parkway, Jacksonville, FL, 32224, US |
| Mail Address: | 11555 Central Parkway, Jacksonville, FL, 32224, US |
| ZIP code: | 32224 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902239270 | 2013-08-09 | 2018-08-10 | 10151 DEERWOOD PARK BLVD STE 200-250, JACKSONVILLE, FL, 322560589, US | 10151 DEERWOOD PARK BLVD STE 200-250, JACKSONVILLE, FL, 32256, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-704-2527 |
Authorized person
| Name | TRACY M RILEY |
| Role | OWNER |
| Phone | 9047042527 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH 5716 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW9355 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| License Number | ME0045122 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008697300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RILEY TRACY | Agent | 11555 Central Parkway, Jacksonville, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| RILEY TRACY | Managing Member | 11555 Central Parkway, Jacksonville, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-14 | 11555 Central Parkway, Suite 701, Jacksonville, FL 32224 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-14 | 11555 Central Parkway, Suite 701, Jacksonville, FL 32224 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-14 | 11555 Central Parkway, Suite 701, Jacksonville, FL 32224 | No data |
| LC AMENDMENT AND NAME CHANGE | 2017-09-25 | TRACY RILEY COUNSELING, LLC | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-23 | RILEY, TRACY | No data |
| REINSTATEMENT | 2011-04-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-01-15 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-06-14 |
| ANNUAL REPORT | 2019-03-24 |
| ANNUAL REPORT | 2018-01-25 |
| LC Amendment and Name Change | 2017-09-25 |
| ANNUAL REPORT | 2017-02-19 |
| ANNUAL REPORT | 2016-03-13 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
