| Entity Name: | LAKE NONA BEHAVIORAL HEALTH SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Oct 2017 (7 years ago) |
| Document Number: | L17000211844 |
| FEI/EIN Number | 82-3077313 |
| Address: | 12617 NARCOOSSEE RD, ORLANDO, FL, 32832, US |
| Mail Address: | 12617 NARCOOSSEE RD, ORLANDO, FL, 32832, US |
| ZIP code: | 32832 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578108668 | 2019-11-12 | 2022-11-25 | 10437 MOSS PARK RD STE B, ORLANDO, FL, 328325812, US | 10437 MOSS PARK RD STE B, ORLANDO, FL, 328325812, US | |||||||||||||||||||||||
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| Phone | +1 407-808-5773 |
| Fax | 3212369134 |
Authorized person
| Name | DR. SYLVIA JOHNSON |
| Role | OWNER |
| Phone | 4078085773 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JOHNSON SYLVIA BDR. | Agent | 12617 NARCOOSSEE RD, ORLANDO, FL, 32832 |
| Name | Role | Address |
|---|---|---|
| JOHNSON SYLVIA B | Manager | 12617 NARCOOSSEE RD, ORLANDO, FL, 32832 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JR STANLEY E | Auth | 12617 NARCOOSSEE RD, ORLANDO, FL, 32832 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-30 | 12617 NARCOOSSEE RD, SUITE 110, ORLANDO, FL 32832 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 12617 NARCOOSSEE RD, SUITE 110, ORLANDO, FL 32832 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 12617 NARCOOSSEE RD, SUITE 110, ORLANDO, FL 32832 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-04-24 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-17 |
| Florida Limited Liability | 2017-10-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
