| Entity Name: | SHORELINE PSYCHOLOGICAL SERVICES,PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Jun 2015 (10 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 27 Jan 2022 (3 years ago) |
| Document Number: | L15000095216 |
| FEI/EIN Number | 47-4214106 |
| Address: | 5720 5th Ave North, St. Petersburg, FL, 33710, US |
| Mail Address: | 5720 5th Ave North, St. Petersburg, FL, 33710, US |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093257982 | 2016-11-09 | 2023-06-16 | 146 2ND ST N, SUITE 310, ST PETERSBURG, FL, 337013328, US | 146 2ND ST N, SUITE 310, ST PETERSBURG, FL, 337013328, US | |||||||||||||||||
|
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| Phone | +1 727-251-6874 |
Authorized person
| Name | DR. THEODORA COFFMAN |
| Role | PSYCHOLOGIST |
| Phone | 7273081180 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | PY9365 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHORELINE PSYCHOLOGICAL SERVICES 401(K) PLAN | 2023 | 474214106 | 2024-10-14 | SHORELINE PSYCHOLOGICAL SERVICES, PLLC | 2 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2024-10-14 |
| Name of individual signing | THEODORA P COFFMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621330 |
| Sponsor’s telephone number | 7272896583 |
| Plan sponsor’s address | 146 2ND STREET NORTH, SUITE 305, SAINT PETERSBURG, FL, 33712 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-13 |
| Name of individual signing | THEODORA P COFFMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| COFFMAN THEODORA P | Agent | 5720 5th Ave North, St. Petersburg, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| COFFMAN THEODORA P | Manager | 5720 5th Ave North, St. Petersburg, FL, 33710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-12-07 | 5720 5th Ave North, St. Petersburg, FL 33710 | No data |
| CHANGE OF MAILING ADDRESS | 2023-12-07 | 5720 5th Ave North, St. Petersburg, FL 33710 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-12-07 | 5720 5th Ave North, St. Petersburg, FL 33710 | No data |
| LC NAME CHANGE | 2022-01-27 | SHORELINE PSYCHOLOGICAL SERVICES,PLLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-01-17 |
| AMENDED ANNUAL REPORT | 2023-12-07 |
| ANNUAL REPORT | 2023-01-22 |
| LC Name Change | 2022-01-27 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
