| Entity Name: | COASTAL ABA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 25 Jul 2017 (8 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L17000158301 |
| Address: | 6001 41ST AVE N, ST. PETERSBURG, FL 33709 |
| Mail Address: | 6001 41ST AVE N, ST. PETERSBURG, FL 33709 |
| ZIP code: | 33709 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851800726 | 2017-09-23 | 2017-09-23 | 3135 1ST AVE N, PO BOX 12844, ST. PETERSBURG, FL, 33730, US | 6001 41ST AVE N, ST PETERSBURG, FL, 337095221, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-999-0583 |
| Fax | 8553062505 |
| Phone | +1 727-656-6045 |
| Fax | 7276566045 |
Authorized person
| Name | LAUREN ALTMAN BRUM |
| Role | OWNER, BEHAVIOR ANALYST |
| Phone | 7278883296 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1073972451 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1700266871 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRUM, LAUREN | Agent | 6001 41ST AVE N, ST. PETERSBURG, FL 33709 |
| Name | Role | Address |
|---|---|---|
| BRUM, LAUREN | Authorized Representative | 6001 41ST AVE N, ST. PETERSBURG, FL 33709 |
| MCVEIGH, JAMIE LEE | Authorized Representative | 3011 6TH AVE N, ST. PETERSBURG, FL 33713 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2017-07-25 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
