| Entity Name: | BETH LILJESTRAND LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Dec 2017 (7 years ago) |
| Document Number: | L17000261105 |
| FEI/EIN Number | 82-3771603 |
| Address: | 1425 Piedmont Drive East, STE. 304, TALLAHASSEE, FL, 32308, US |
| Mail Address: | 1425 Piedmont Drive East, STE. 304, TALLAHASSEE, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306333935 | 2018-04-19 | 2018-06-16 | 3201 SHAMROCK ST S STE 103, TALLAHASSEE, FL, 323093349, US | 3201 SHAMROCK ST S STE 103, TALLAHASSEE, FL, 323093349, US | |||||||||||||||||||||||||
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| Phone | +1 850-661-5466 |
| Fax | 8508940062 |
Authorized person
| Name | MRS. BETH ANN LILJESTRAND |
| Role | THERAPIST/PRIVATE PRACTITIONER |
| Phone | 8506615466 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 7203 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1318096 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LILJESTRAND BETH A | Agent | 3233 ARBOR HILL WAY, TALLAHASSEE, FL, 32309 |
| Name | Role | Address |
|---|---|---|
| Liljestrand Beth AMrs. | Manager | 3201 SHAMROCK STREET, SOUTH, TALLAHASSEE, FL, 32309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-28 | 1425 Piedmont Drive East, STE. 304, TALLAHASSEE, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-28 | 1425 Piedmont Drive East, STE. 304, TALLAHASSEE, FL 32308 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-01-07 |
| ANNUAL REPORT | 2018-09-10 |
| Florida Limited Liability | 2017-12-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
