| Entity Name: | MTB THERAPIST LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Jan 2018 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Feb 2020 (5 years ago) |
| Document Number: | L18000004480 |
| FEI/EIN Number | 82-3930984 |
| Address: | 3452 LIVE OAK HOLLOW DR, ORANGE PARK, FL, 32065, US |
| Mail Address: | 3452 LIVE OAK HOLLOW DR, ORANGE PARK, FL, 32065, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003314790 | 2018-01-27 | 2018-04-05 | 6034 CHESTER AVE, JACKSONVILLE, FL, 322172264, US | 6034 CHESTER AVE, JACKSONVILLE, FL, 322172264, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-323-2019 |
Authorized person
| Name | MERLAND BAKER |
| Role | DIRECTOR |
| Phone | 9043232019 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| License Number | 15468 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| License Number | 15468 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 15468 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| License Number | 15468 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 261QM0801X - CLINIC/CENTER - MENTAL HEALTH (INCLUDING COMMUNITY MENTAL HEALTH CE |
| Number | MH15468 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAKER MERLAND | Agent | 3452 LIVE OAK HOLLOW DR, ORANGE PARK, FL, 32065 |
| Name | Role | Address |
|---|---|---|
| BAKER MERLAND | Manager | 3452 LIVE OAK HOLLOW DR, ORANGE PARK, FL, 32065 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-02-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-01 | BAKER, MERLAND | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-09-08 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-06 |
| REINSTATEMENT | 2020-02-01 |
| Florida Limited Liability | 2018-01-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
