| Entity Name: | PSYCHOLOGY ASSOCIATES OF BREVARD, PLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Oct 2011 (13 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 19 Oct 2011 (13 years ago) |
| Document Number: | L11000120025 |
| FEI/EIN Number | 593419280 |
| Address: | 6767 N WICKHAM ROAD, SUITE 306, MELBOURNE, FL, 32940 |
| Mail Address: | 6767 N WICKHAM ROAD, SUITE 306, MELBOURNE, FL, 32940 |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1922200278 | 2007-05-31 | 2012-03-07 | 6767 N WICKHAM RD, SUITE 306, MELBOURNE, FL, 329402031, US | 6767 N WICKHAM RD, SUITE 306, MELBOURNE, FL, 329402031, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-751-1925 |
| Fax | 3217519261 |
Authorized person
| Name | PATTY HELLER |
| Role | OFFICE MANAGER |
| Phone | 3217511925 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH5001 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH3865 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| License Number | PY7627 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY2592 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY4859 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | ME79036 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| OLSEN KRISTOPHER | Agent | 6767 N. WICKHAM RD., SUITE 306, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| OLSEN KRISTOPHER P | Managing Member | 6767 N WICKMAN RD., SUITE 306, MELBOURNE, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000102389 | PSYCHOLOGY ASSOCIATES OF BREVARD | ACTIVE | 2011-10-21 | 2026-12-31 | No data | 6767 N WICKHAM RD, SUITE 306, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-05-19 | OLSEN, KRISTOPHER | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-05-19 | 6767 N. WICKHAM RD., SUITE 306, MELBOURNE, FL 32940 | No data |
| CONVERSION | 2011-10-19 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P97000002156. CONVERSION NUMBER 700000117087 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| Reg. Agent Change | 2023-05-19 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-05-14 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
