| Entity Name: | ADAPT & TRANSFORM BEHAVIOR LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Jun 2017 (8 years ago) |
| Document Number: | L17000137034 |
| FEI/EIN Number | 82-1956716 |
| Address: | 4518 3rd Ave S, St. Peterburg, FL, 33711, US |
| Mail Address: | PO BOX 530638, ST PETERSBURG, FL, 33747, US |
| ZIP code: | 33711 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568171262 | 2022-11-21 | 2022-11-22 | 822 PROVIDENCE TRACE CIR APT 303, BRANDON, FL, 335114076, US | 1400 GANDY BLVD N UNIT 204, ST PETERSBURG, FL, 337022118, US | |||||||||||||||||||||
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| Phone | +1 813-922-9578 |
| Phone | +1 727-417-3269 |
Authorized person
| Name | ERIN PEEL |
| Role | RBT |
| Phone | 8139229578 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | C145176955880 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Kieffer Emily C | Agent | 4518 3rd Ave S, Saint Petersburg, FL, 33711 |
| Name | Role | Address |
|---|---|---|
| KIEFFER EMILY | Manager | 4518 3rd Ave S, St. Peterburg, FL, 33711 |
| FUESY SAMANTHA | Manager | 5210 20th Ave S, Gulfport, FL, 33707 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000091692 | HOLISTIC LEARNING CENTER | ACTIVE | 2024-08-01 | 2029-12-31 | No data | 6465 1ST AVE S, SAINT PETERSBURG, FL, 33707 |
| G19000008966 | ATBX | ACTIVE | 2019-01-17 | 2029-12-31 | No data | PO BOX 530638, ST. PETERSBURG, FL, 33747 |
| G17000070457 | AT BEHAVIOR | EXPIRED | 2017-06-28 | 2022-12-31 | No data | 1400 GANDY BLVD N, UNIT 204, ST. PETERSBURG, FL, 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-09 | 4518 3rd Ave S, St. Peterburg, FL 33711 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-09 | 4518 3rd Ave S, Saint Petersburg, FL 33711 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-08 | 4518 3rd Ave S, St. Peterburg, FL 33711 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-08 | Kieffer, Emily Catherine | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-02-13 |
| ANNUAL REPORT | 2020-03-14 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-02-23 |
| Florida Limited Liability | 2017-06-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
