| Entity Name: | METAMORPHOSIS PSYCHE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 2017 (7 years ago) |
| Document Number: | L17000237791 |
| FEI/EIN Number | 82-3495628 |
| Address: | 8333 West McNab Road, Tamarac, FL, 33321, US |
| Mail Address: | P.O. BOX 101077, FORT LAUDERDALE, FL, 33310, US |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356855639 | 2017-11-26 | 2023-04-10 | PO BOX 101077, FORT LAUDERDALE, FL, 333101077, US | 6101 W ATLANTIC BLVD STE 202, MARGATE, FL, 330635157, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 954-906-4106 |
| Fax | 9549064029 |
Authorized person
| Name | DR. CELESTE BOYD |
| Role | CEO, MGR, DNP |
| Phone | 9549064106 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 9295246 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | APRN |
| Number | 9295246 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOYD CELESTE | Agent | 8333 West McNab Road, Tamarac, FL, 33321 |
| Name | Role | Address |
|---|---|---|
| BOYD CELESTE | Chief Executive Officer | 8333 West McNab Road, Tamarac, FL, 33321 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-19 | 8333 West McNab Road, Suite 200, Tamarac, FL 33321 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-19 | 8333 West McNab Road, Suite 200, Tamarac, FL 33321 | No data |
| CHANGE OF MAILING ADDRESS | 2018-05-29 | 8333 West McNab Road, Suite 200, Tamarac, FL 33321 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-03-26 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-02-16 |
| ANNUAL REPORT | 2018-01-21 |
| Florida Limited Liability | 2017-11-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
