| Entity Name: | TETRICK COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Oct 2010 (14 years ago) |
| Document Number: | L10000105933 |
| FEI/EIN Number | 273646784 |
| Address: | 924 N Magnolia Ave., ORLANDO, FL, 32803, US |
| Mail Address: | 1151 Banbury Tr, Maitland, FL, 32751, US |
| ZIP code: | 32803 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104136647 | 2010-10-18 | 2011-03-31 | 1223 LAKE HIGHLAND DR, ORLANDO, FL, 328032601, US | 2020 E ROBINSON ST, ORLANDO, FL, 328036045, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-929-6821 |
| Fax | 4078982805 |
Authorized person
| Name | MARTINA TETRICK |
| Role | OWNER |
| Phone | 4079296821 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | MH7529 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 759031801 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TETRICK MARTINA | Agent | 1151 Banbury Tr, Maitland, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| TETRICK MARTINA | Managing Member | 1151 Banbury Tr, Maitland, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-10 | 924 N Magnolia Ave., Suite 138, ORLANDO, FL 32803 | No data |
| CHANGE OF MAILING ADDRESS | 2017-02-28 | 924 N Magnolia Ave., Suite 138, ORLANDO, FL 32803 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-28 | 1151 Banbury Tr, Maitland, FL 32751 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-02-14 |
| ANNUAL REPORT | 2022-02-10 |
| ANNUAL REPORT | 2021-02-26 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-01-25 |
| ANNUAL REPORT | 2018-03-23 |
| ANNUAL REPORT | 2017-02-28 |
| ANNUAL REPORT | 2016-02-24 |
| ANNUAL REPORT | 2015-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
