| Entity Name: | FIRST COAST COUNSELING L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Apr 2017 (8 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Nov 2017 (7 years ago) |
| Document Number: | L17000074167 |
| FEI/EIN Number | 82-1036167 |
| Address: | 1390 Outback Road, Saint Cloud, FL, 34771, US |
| Mail Address: | 1390 Outback Road, Saint Cloud, FL, 34771, US |
| ZIP code: | 34771 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033641543 | 2017-04-03 | 2017-04-03 | 2478 1ST AVE, UNIT A, FERNANDINA BEACH, FL, 320346386, US | 910 S 8TH ST, SUITE 121, FERNANDINA BEACH, FL, 320343744, US | |||||||||||||||||||||||
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| Phone | +1 904-432-8603 |
Authorized person
| Name | MR. BARTON JAMES BOTT |
| Role | MANAGING MEMBER |
| Phone | 9044328603 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH-6275 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 643794 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOTT FAY A | Agent | 1390 Outback Road, Saint Cloud, FL, 34771 |
| Name | Role | Address |
|---|---|---|
| BOTT BARTON J | Manager | 1390 Outback Road, Saint Cloud, FL, 34771 |
| Name | Role | Address |
|---|---|---|
| BOTT FAY A | Authorized Member | 1390 Outback Road, Saint Cloud, FL, 34771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-22 | 1390 Outback Road, Saint Cloud, FL 34771 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-22 | 1390 Outback Road, Saint Cloud, FL 34771 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-22 | 1390 Outback Road, Saint Cloud, FL 34771 | No data |
| LC AMENDMENT | 2017-11-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-22 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-08 |
| ANNUAL REPORT | 2019-01-11 |
| ANNUAL REPORT | 2018-01-18 |
| LC Amendment | 2017-11-20 |
| Florida Limited Liability | 2017-04-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
