| Entity Name: | CASA FELIZ COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Aug 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Nov 2017 (7 years ago) |
| Document Number: | L15000145060 |
| FEI/EIN Number | 81-2421339 |
| Address: | 2425 S VOLUSIA AVENUE, ORANGE CITY, FL, 32763, US |
| Mail Address: | 2425 S VOLUSIA AVENUE, ORANGE CITY, FL, 32763, US |
| ZIP code: | 32763 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912439274 | 2017-03-28 | 2024-08-15 | 2425 S VOLUSIA AVE STE B4, ORANGE CITY, FL, 327637625, US | 2425 S VOLUSIA AVE STE B4, ORANGE CITY, FL, 327637625, US | |||||||||||||||||||||||||
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| Phone | +1 321-578-7488 |
| Fax | 8775401113 |
Authorized person
| Name | GRACIELA PULLIAM |
| Role | CEO/OWNER |
| Phone | 3215787488 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH9913 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014378900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Pulliam Graciela | Agent | 3467 Heath Drive, Deltona, FL, 32725 |
| Name | Role | Address |
|---|---|---|
| PULLIAM GRACIELA | Authorized Member | 3467 HEATH DR., DELTONA, FL, 32725 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-13 | 2425 S VOLUSIA AVENUE, UNIT B4, ORANGE CITY, FL 32763 | No data |
| CHANGE OF MAILING ADDRESS | 2021-11-13 | 2425 S VOLUSIA AVENUE, UNIT B4, ORANGE CITY, FL 32763 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-19 | Pulliam, Graciela | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-30 | 3467 Heath Drive, Deltona, FL 32725 | No data |
| REINSTATEMENT | 2017-11-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-01-19 |
| ANNUAL REPORT | 2020-03-27 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-02-26 |
| REINSTATEMENT | 2017-11-09 |
| ANNUAL REPORT | 2016-04-25 |
| Florida Limited Liability | 2015-08-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
