| Entity Name: | PSYWELL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Sep 2017 (7 years ago) |
| Document Number: | L17000189808 |
| FEI/EIN Number | 82-2708909 |
| Address: | 8401 LAKE WORTH RD., SUITE 210, LAKE WORTH, FL 33467 |
| Mail Address: | 8401 LAKE WORTH RD., SUITE 210, LAKE WORTH, FL 33467 |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386289601 | 2019-11-11 | 2024-10-30 | 6803 LAKE WORTH RD STE 215, GREENACRES, FL, 334672979, US | 6803 LAKE WORTH RD STE 215, GREENACRES, FL, 334672979, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 561-207-7625 |
Authorized person
| Name | DR. PAULA SHAW |
| Role | PSYCHOLOGIST |
| Phone | 5612077625 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 103TC2200X - Clinical Child & Adolescent Psychologist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SHAW, PAULA | Agent | 8870 GEORGETOWN LANE, BOYNTON BEACH, FL 33472 |
| Name | Role | Address |
|---|---|---|
| SHAW, PAULA | Manager | 8870 GEORGETOWN LANE, BOYNTON BEACH, FL 33472 |
| LIPPMAN, STEPHANIE | Manager | 9755 QUINN COURT, WELLINGTON, FL 33414 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000108640 | PSYCHOLOGICAL WELLNESS CENTER | ACTIVE | 2017-10-02 | 2027-12-31 | No data | 8401 LAKE WORTH RD., SUITE 210, LAKE WORTH, FL, 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-07 | 8401 LAKE WORTH RD., SUITE 210, LAKE WORTH, FL 33467 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-07 | 8401 LAKE WORTH RD., SUITE 210, LAKE WORTH, FL 33467 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-28 |
| ANNUAL REPORT | 2023-02-23 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-16 |
| ANNUAL REPORT | 2020-03-11 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-04-12 |
| Florida Limited Liability | 2017-09-07 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
