| Entity Name: | ALYSSA BUCHANAN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Jan 2016 (9 years ago) |
| Document Number: | L16000003393 |
| FEI/EIN Number | 81-1061644 |
| Address: | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 |
| Mail Address: | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 |
| ZIP code: | 32904 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487194817 | 2017-03-04 | 2022-01-12 | 630 S WICKHAM RD STE 107, WEST MELBOURNE, FL, 329041429, US | 630 S WICKHAM RD STE 107, WEST MELBOURNE, FL, 329041429, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 321-608-0604 |
| Fax | 3216080604 |
Authorized person
| Name | ALYSSA BUCHANAN |
| Role | OWNER |
| Phone | 3216080604 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW12384 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014820300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BUCHANAN, ALYSSA | Agent | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 |
| Name | Role | Address |
|---|---|---|
| Buchanan, Alyssa R | Manager | 630 S. Wickham Rd., Ste. 107 West Melbourne, FL 32904 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000021753 | SKYLIGHT COUNSELING SERVICES | ACTIVE | 2017-02-28 | 2027-12-31 | No data | 630 S. WICKHAM RD., STE. 107, WEST MELBOURNE, FL, 32904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-24 | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-24 | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-24 | 630 S. Wickham Rd., Ste. 107, West Melbourne, FL 32904 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-05-29 |
| ANNUAL REPORT | 2020-06-24 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-02-22 |
| ANNUAL REPORT | 2017-02-28 |
| Florida Limited Liability | 2016-01-05 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7142387806 | 2020-06-03 | 0455 | PPP | 630 S Wickham Rd. Suite 107, West Melbourne, FL, 32904-1428 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 19 Feb 2025
Sources: Florida Department of State
