| Entity Name: | LAURIE MINTZ, PH.D, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jan 2015 (10 years ago) |
| Document Number: | L15000003894 |
| FEI/EIN Number | 47-2738582 |
| Address: | 6304 SW 95TH STREET, GAINESVILLE, FL, 32608, US |
| Mail Address: | 6304 SW 95TH STREET, GAINESVILLE, FL, 32608, US |
| ZIP code: | 32608 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346633864 | 2015-03-09 | 2015-03-09 | 6304 SW 95TH ST, GAINESVILLE, FL, 326085565, US | 2830 NW 41ST ST, SUITE D, GAINESVILLE, FL, 326066667, US | |||||||||||||||||||||||
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| Phone | +1 573-808-3828 |
Authorized person
| Name | DR. LAURIE MINTZ |
| Role | LICENSED PSYCHOLOGIST |
| Phone | 5738083828 |
Taxonomy
| Taxonomy Code | 103TC1900X - Counseling Psychologist |
| License Number | PY8648 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE PROVIDER NUMBER |
| Number | 599OU |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PYE THOMAS G | Agent | 3909 W NEWBERRY RD, GAINESVILLE, FL, 32607 |
| Name | Role | Address |
|---|---|---|
| MINTZ LAURIE B | Authorized Member | 6304 SW 95TH STREET, GAINESVILLE, FL, 32608 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-05 |
| ANNUAL REPORT | 2024-01-07 |
| ANNUAL REPORT | 2023-01-08 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-11 |
| ANNUAL REPORT | 2019-01-19 |
| ANNUAL REPORT | 2018-01-06 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
