| Entity Name: | VERA MATEJIC LCSW, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Jun 2017 (8 years ago) |
| Document Number: | L17000128000 |
| FEI/EIN Number | 82-2137386 |
| Address: | 1325 MAHAN DR, TALLAHASSEE, FL, 32308, US |
| Mail Address: | 1325 MAHAN DR, TALLAHASSEE, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821576620 | 2018-08-02 | 2018-08-02 | 123 WHETHERBINE WAY W, TALLAHASSEE, FL, 323018536, US | 1325 E TENNESSEE ST OFC 2, TALLAHASSEE, FL, 323085107, US | |||||||||||||||||||||||
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| Phone | +1 305-331-8053 |
Authorized person
| Name | MRS. VERA MATEJIC |
| Role | OWNER/THERAPIST |
| Phone | 3053318053 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | SW13325 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017060800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MATEJIC VERA | Agent | 1325 MAHAN DR, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| MATEJIC VERA | Manager | 1325 MAHAN DR, TALLAHASSEE, FL, 32308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-30 | 1325 MAHAN DR, OFFICE 2, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-30 | 1325 MAHAN DR, OFFICE 2, TALLAHASSEE, FL 32308 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-30 | 1325 MAHAN DR, OFFICE 2, TALLAHASSEE, FL 32308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-05-25 |
| ANNUAL REPORT | 2019-05-08 |
| ANNUAL REPORT | 2018-04-30 |
| Florida Limited Liability | 2017-06-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
