| Entity Name: | CONCORD COUNSELING CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Aug 2016 (9 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L16000151557 |
| FEI/EIN Number | 81-3559699 |
| Mail Address: | PO BOX 580264, KISSIMMEE, FL, 34758, US |
| Address: | 4545 Pleasant Hill RD, Suite 101, Kissimmee, FL, 34759, US |
| ZIP code: | 34759 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932650058 | 2016-10-24 | 2017-04-05 | 897 TOWNE CENTER DR, SUITE 101, KISSIMMEE, FL, 347593469, US | 897 TOWNE CENTER DR, SUITE 101, KISSIMMEE, FL, 347593469, US | |||||||||||||||||||||||||
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| Phone | +1 407-530-5206 |
| Fax | 4075305198 |
Authorized person
| Name | MRS. CYNTHIA ANN KLEE |
| Role | OWNER |
| Phone | 4075305206 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 10841 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010370700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KLEE CYNTHIA A | Agent | 4545 Pleasant Hill RD, Kissimmee, FL, 34759 |
| Name | Role | Address |
|---|---|---|
| KLEE CYNTHIA A | Chief Executive Officer | 4545 Pleasant Hill RD, Kissimmee, FL, 34759 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-14 | 4545 Pleasant Hill RD, Suite 101, Kissimmee, FL 34759 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-14 | 4545 Pleasant Hill RD, Suite 101, Kissimmee, FL 34759 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-02 | 4545 Pleasant Hill RD, Suite 101, Kissimmee, FL 34759 | No data |
| LC AMENDMENT | 2018-09-04 | No data | No data |
| LC AMENDMENT | 2017-08-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-05-14 |
| ANNUAL REPORT | 2019-02-02 |
| LC Amendment | 2018-09-04 |
| ANNUAL REPORT | 2018-03-23 |
| LC Amendment | 2017-08-21 |
| ANNUAL REPORT | 2017-02-14 |
| Florida Limited Liability | 2016-08-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
