| Entity Name: | MCMAKEN COUNSELING AND SUPPORT SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jan 2018 (7 years ago) |
| Document Number: | L18000027697 |
| FEI/EIN Number | 82-4369235 |
| Address: | 415 R. Jackson Blvd, PANAMA CITY BEACH, FL, 32407, US |
| Mail Address: | 415 R. Jackson Blvd, PANAMA CITY BEACH, FL, 32407, US |
| ZIP code: | 32407 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689298341 | 2020-05-28 | 2024-07-03 | 415 N RICHARD JACKSON BLVD STE 206B, PANAMA CITY BEACH, FL, 324073694, US | 415 N RICHARD JACKSON BLVD STE 206B, PANAMA CITY BEACH, FL, 324073694, US | |||||||||||||||||||||
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| Phone | +1 303-618-5614 |
| Fax | 8502482469 |
Authorized person
| Name | MRS. SANDI GAY |
| Role | BILLING MANAGER |
| Phone | 8502482468 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025008100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| McMaken Brooke | Agent | 415 R. Jackson Blvd, PANAMA CITY BEACH, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| MCMAKEN BROOKE | Manager | 415 R. Jackson Blvd, PANAMA CITY BEACH, FL, 32407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-16 | 415 R. Jackson Blvd, 206B, PANAMA CITY BEACH, FL 32407 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-16 | 415 R. Jackson Blvd, 206B, PANAMA CITY BEACH, FL 32407 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-16 | 415 R. Jackson Blvd, 206B, PANAMA CITY BEACH, FL 32407 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-26 | McMaken, Brooke | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-16 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-26 |
| ANNUAL REPORT | 2019-04-12 |
| Florida Limited Liability | 2018-01-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
