| Entity Name: | NELSON PSYCHOLOGICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Feb 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Jan 2018 (7 years ago) |
| Document Number: | L12000017985 |
| FEI/EIN Number | 455299391 |
| Address: | 8360 WEST OAKLAND PARK BLVD., Sunrise, FL, 33351, US |
| Mail Address: | 8360 WEST OAKLAND PARK BLVD., SUITE 303, SUNRISE, FL, 33351, US |
| ZIP code: | 33351 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548814189 | 2019-07-31 | 2020-06-15 | 8360 W OAKLAND PARK BLVD STE 301F&G, SUNRISE, FL, 333517332, US | 8360 W OAKLAND PARK BLVD STE 301F&G, SUNRISE, FL, 333517332, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-404-5483 |
| Fax | 9413283575 |
Authorized person
| Name | TIESHA S NELSON |
| Role | CEO |
| Phone | 9542948139 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| NELSON TIESHA Psy.D. | Agent | 8360 WEST OAKLAND PARK BLVD., Sunrise, FL, 33351 |
| Name | Role | Address |
|---|---|---|
| NELSON TIESHA PSY.D. | Manager | 8360 WEST OAKLAND PARK BLVD., SUNRISE, FL, 33351 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-11 | 8360 WEST OAKLAND PARK BLVD., SUITE 303, Sunrise, FL 33351 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-11 | 8360 WEST OAKLAND PARK BLVD., SUITE 303, Sunrise, FL 33351 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-11 | 8360 WEST OAKLAND PARK BLVD., SUITE 303, Sunrise, FL 33351 | No data |
| REINSTATEMENT | 2018-01-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-01-25 | NELSON, TIESHA, Psy.D. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2013-10-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-06-15 |
| ANNUAL REPORT | 2019-05-07 |
| REINSTATEMENT | 2018-01-25 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-01-26 |
| ANNUAL REPORT | 2014-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
