| Entity Name: | KRISTI VAN SICKLE, PSYD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Apr 2015 (10 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 20 Oct 2017 (7 years ago) |
| Document Number: | L15000060240 |
| FEI/EIN Number | 47-3657473 |
| Address: | DBA COLLABORATIVE PSYCHOLOGICAL SERVICES, 163 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701, US |
| Mail Address: | DBA COLLABORATIVE PSYCHOLOGICAL SERVICES, 163 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701, US |
| ZIP code: | 33701 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902292725 | 2015-04-08 | 2022-07-13 | 163 5TH AVE NE, SAINT PETERSBURG, FL, 337013015, US | 163 5TH AVE NE, SAINT PETERSBURG, FL, 337013015, US | |||||||||||||||||
|
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| Phone | +1 727-586-5192 |
Authorized person
| Name | KRISTI SANDS VAN SICKLE |
| Role | OWNER/PSYCHOLOGIST |
| Phone | 7275925186 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| License Number | PY7640 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VAN SICKLE KRISTI S | Agent | 151 5TH AVE NE, SAINT PETERSBURG, FL, 33701 |
| Name | Role | Address |
|---|---|---|
| VAN SICKLE KRISTI S | Authorized Representative | 151 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701 |
| VAN SICKLE PAUL B | Authorized Representative | 151 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000120500 | COLLABORATIVE PSYCHOLOGICAL SERVICES | EXPIRED | 2017-11-01 | 2022-12-31 | No data | 151 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701 |
| G17000113954 | COLLLABORATIVE PSYCHOLOGICAL SERVICES | ACTIVE | 2017-10-16 | 2027-12-31 | No data | 163 5TH AVENUE NE, SAINT PETERSBURG, FL, 33701 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2017-10-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-10-20 | DBA COLLABORATIVE PSYCHOLOGICAL SERVICES, 163 5TH AVENUE NE, SAINT PETERSBURG, FL 33701 | No data |
| CHANGE OF MAILING ADDRESS | 2017-10-20 | DBA COLLABORATIVE PSYCHOLOGICAL SERVICES, 163 5TH AVENUE NE, SAINT PETERSBURG, FL 33701 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-10-20 | VAN SICKLE, KRISTI S | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-10-20 | 151 5TH AVE NE, SAINT PETERSBURG, FL 33701 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-03-31 |
| CORLCRACHG | 2017-10-20 |
| ANNUAL REPORT | 2017-02-12 |
| ANNUAL REPORT | 2016-03-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
