| Entity Name: | CHANGING TREE WELLNESS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Feb 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Dec 2022 (2 years ago) |
| Document Number: | L12000024564 |
| FEI/EIN Number | 90-0881044 |
| Address: | 1111 North Parrot Ave, OKEECHOBEE, FL, 34974, US |
| Mail Address: | 1111 North Parrot Ave, OKEECHOBEE, FL, 34974, US |
| ZIP code: | 34974 |
| County: | Okeechobee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245588409 | 2012-08-20 | 2014-02-03 | 203 SE 2ND AVE, OKEECHOBEE, FL, 349744305, US | 203 SE 2ND AVE, OKEECHOBEE, FL, 349744305, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 863-261-8900 |
| Fax | 8632791156 |
Authorized person
| Name | DR. ELLISA SCOTT |
| Role | CEO/OWNER |
| Phone | 8632618900 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| License Number | MH10761 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH10761 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| License Number | MH10761 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 102L00000X - Psychoanalyst |
| License Number | MH10761 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003835200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Scott Ellisa | Agent | 111 E. Monument Ave, Kissimmee, FL, 34741 |
| Name | Role | Address |
|---|---|---|
| SCOTT ELLISA Phd | Chief Executive Officer | 111 E. Monument Ave, Kissimmee, FL, 34741 |
| Name | Role | Address |
|---|---|---|
| SCOTT ELLISA Phd | President | 111 E. Monument Ave, Kissimmee, FL, 34741 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000075633 | CHANGING TREE WELLNESS CENTER, INC. | EXPIRED | 2012-07-30 | 2017-12-31 | No data | 120 BROADWAY SUITE206, KISSIMMEE, FL, 34741 |
| G12000072549 | CHANGING TREE BEHAVIORAL SERVICES, LLC. | EXPIRED | 2012-07-20 | 2017-12-31 | No data | 120 BROADWAY SUITE206, KISSIMMEE, FL, 34741 |
| G12000070893 | CHANGE BEHAVIORAL SERVICES | EXPIRED | 2012-07-16 | 2017-12-31 | No data | 120 BROADWAY SUITE206, KISSIMMEE, FL, 34741 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-12-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-07-16 | 1111 North Parrot Ave, OKEECHOBEE, FL 34974 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-07-16 | 111 E. Monument Ave, 332, Kissimmee, FL 34741 | No data |
| CHANGE OF MAILING ADDRESS | 2018-07-16 | 1111 North Parrot Ave, OKEECHOBEE, FL 34974 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-07-16 | Scott, Ellisa | No data |
| LC AMENDMENT AND NAME CHANGE | 2013-04-25 | CHANGING TREE WELLNESS CENTER, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-04-29 |
| AMENDED ANNUAL REPORT | 2022-12-18 |
| REINSTATEMENT | 2022-12-14 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-30 |
| AMENDED ANNUAL REPORT | 2018-07-16 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
