| Entity Name: | COLLABORATIVE PSYCH & MED, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
COLLABORATIVE PSYCH & MED, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 22 Aug 2018 (7 years ago) |
| Date of dissolution: | 24 Sep 2021 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (4 years ago) |
| Document Number: | L18000200718 |
| FEI/EIN Number |
83-1706764
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3353 Victoria Manor Drive, LAKELAND, FL, 33805, US |
| Mail Address: | 3353 Victoria Manor Drive, LAKELAND, FL, 33805, US |
| ZIP code: | 33805 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972088912 | 2018-09-26 | 2018-09-26 | 4406 S FLORIDA AVE STE 31, LAKELAND, FL, 338132176, US | 4406 S FLORIDA AVE STE 31, LAKELAND, FL, 338132176, US | |||||||||||||||||||||||
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| Phone | +1 855-732-5292 |
| Fax | 8635839926 |
Authorized person
| Name | KELLY WOOD |
| Role | ADMINISTRATOR |
| Phone | 8557325292 |
Taxonomy
| Taxonomy Code | 103TA0700X - Adult Development & Aging Psychologist |
| Is Primary | No |
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MOORE JULIUS DDR. | Manager | 4404 S FLORIDA AVENUE, LAKELAND, FL, 33813 |
| BRANNEN CATHERINE | Authorized Member | 4404 S FLORIDA AVENUE, LAKELAND, FL, 33813 |
| Brannen Catherine | Agent | 3353 Victoria Manor Drive, LAKELAND, FL, 33805 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | - | - |
| LC AMENDMENT | 2020-07-16 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-22 | 3353 Victoria Manor Drive, K 109, LAKELAND, FL 33805 | - |
| CHANGE OF MAILING ADDRESS | 2020-02-22 | 3353 Victoria Manor Drive, K 109, LAKELAND, FL 33805 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-22 | 3353 Victoria Manor Drive, K 109, LAKELAND, FL 33805 | - |
| REGISTERED AGENT NAME CHANGED | 2019-01-21 | Brannen, Catherine | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J23000458992 | ACTIVE | 1000000964596 | POLK | 2023-09-22 | 2033-09-27 | $ 660.14 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| J21000391429 | ACTIVE | 1000000896845 | POLK | 2021-07-30 | 2031-08-04 | $ 663.92 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| Name | Date |
|---|---|
| LC Amendment | 2020-07-16 |
| ANNUAL REPORT | 2020-02-22 |
| ANNUAL REPORT | 2019-01-21 |
| Florida Limited Liability | 2018-08-22 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
