| Entity Name: | BEHAVIORAL THERAPY ABC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Jun 2017 (8 years ago) |
| Document Number: | L17000128277 |
| FEI/EIN Number | 82-1869633 |
| Address: | 13301 SW 132 AVE, 209, MIAMI, FL 33186 |
| Mail Address: | 13301 SW 132 AVE, 209, MIAMI, FL 33186 |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740702109 | 2017-07-07 | 2022-07-21 | 13301 SW 132ND AVE, MIAMI, FL, 331866188, US | 13301 SW 132ND AVE, MIAMI, FL, 33186, US | |||||||||||||||||||||||
|
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| Phone | +1 786-713-5553 |
Authorized person
| Name | ISMARAY FERNANDEZ |
| Role | OWNER/ADMINISTRATOR |
| Phone | 7867135553 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | L17000128277 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1063769198 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ , ISMARAY, MGR | Agent | 13301 SW 132 AVE, 209, MIAMI, FL 33186 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ , ISMARAY | Manager | 13301 SW 132 AVE, 209 MIAMI, FL 33186 |
| Name | Role | Address |
|---|---|---|
| FUENTES, JAVIER | Authorized Member | 13301 SW 132 AVE, 209 MIAMI, FL 33186 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-03-17 | FERNANDEZ , ISMARAY, MGR | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-12 | 13301 SW 132 AVE, 209, MIAMI, FL 33186 | No data |
| CHANGE OF MAILING ADDRESS | 2018-01-12 | 13301 SW 132 AVE, 209, MIAMI, FL 33186 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-12 | 13301 SW 132 AVE, 209, MIAMI, FL 33186 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-12 |
| Florida Limited Liability | 2017-06-12 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
