| Entity Name: | GULF COAST COUNSELING SERVICES OF BAY COUNTY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 Jan 2011 (14 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L11000006997 |
| FEI/EIN Number | 45-1610122 |
| Address: | 5303 INDIAN BLUFF DRIVE, YOUNGSTOWN, FL 32406 |
| Mail Address: | 5303 INDIAN BLUFF DRIVE, YOUNGSTOWN, FL 32406 |
| ZIP code: | 32406 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720161763 | 2006-10-23 | 2018-06-21 | PO BOX 16693, PANAMA CITY, FL, 324066693, US | 5409 NEHI RD, PANAMA CITY, FL, 324043043, US | |||||||||||||||||||||||||
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| Phone | +1 850-832-9364 |
| Fax | 8507228782 |
Authorized person
| Name | MRS. LAURIE KIDD |
| Role | OWNER |
| Phone | 8508329364 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH6588 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | Z035R |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAKE, BRYAN J | Agent | 5303 INDIAN BLUFF DR., YOUNGSTOWN, FL 32406 |
| Name | Role | Address |
|---|---|---|
| LAKE, BRYAN J | Managing Member | 820 S. WACOUTA AVE., PRAIRIE DU CHIEN, WI 53821 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-20 | 5303 INDIAN BLUFF DR., YOUNGSTOWN, FL 32406 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-20 |
| Florida Limited Liability | 2011-01-18 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
