| Entity Name: | PHYLLIS WALTERS, PH.D., LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 May 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Apr 2022 (3 years ago) |
| Document Number: | L17000115252 |
| FEI/EIN Number | 82-1748063 |
| Address: | 9220 BONITA BEACH ROAD, SUITE 222, BONITA SPRINGS, FL 34135 |
| Mail Address: | 9220 BONITA BEACH ROAD, 222, BONITA SPRINGS, FL 34135 |
| ZIP code: | 34135 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679161491 | 2021-01-07 | 2021-01-07 | 9248 CYPRESS DR N, FORT MYERS, FL, 339675440, US | 9220 BONITA BEACH RD SE STE 222, BONITA SPRINGS, FL, 341354235, US | |||||||||||||||||||||||
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| Phone | +1 239-297-1508 |
| Phone | +1 239-404-9396 |
Authorized person
| Name | MARCO BIANCHI |
| Role | BILLING MANAGER |
| Phone | 2392971508 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| WALTERS, PHYLLIS, DR. | Agent | 16128 PARQUE LANE, NAPLES, FL 34110 |
| Name | Role | Address |
|---|---|---|
| WALTERS, PHYLLIS | Manager | 16128 PARQUE LANE, NAPLES, FL 34110 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-04-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-01 | WALTERS, PHYLLIS, DR. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-28 |
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-22 |
| AMENDED ANNUAL REPORT | 2022-04-16 |
| REINSTATEMENT | 2022-04-01 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-03-22 |
| ANNUAL REPORT | 2018-03-24 |
| Florida Limited Liability | 2017-05-24 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
