| Entity Name: | MARY T HOLCOMB PSYD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Dec 2018 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Sep 2019 (5 years ago) |
| Document Number: | L18000285196 |
| FEI/EIN Number | 83-2724747 |
| Address: | 2700 WESTHALL LANE, 110, MAITLAND, FL, 32751, US |
| Mail Address: | 2700 WESTHALL LANE, 110, MAITLAND, FL, 32751, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730651142 | 2018-12-24 | 2018-12-24 | 914 KERSFIELD CIR, LAKE MARY, FL, 327461936, US | 2700 WESTHALL LN STE 110, MAITLAND, FL, 327517403, US | |||||||||||||||||||||||
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| Phone | +1 407-923-3927 |
| Phone | +1 407-475-1025 |
| Fax | 4074751027 |
Authorized person
| Name | DR. MARY T HOLCOMB |
| Role | MARY T HOLCOMB |
| Phone | 4079233927 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1235154352 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Agent | 2700 WESTHALL LANE, MAITLAND, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Authorized Member | 2700 WESTHALL LANE, SUITE 110, MAITLAND, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-09-29 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-09-29 | HOLCOMB, MARY T | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-06-23 |
| REINSTATEMENT | 2019-09-29 |
| Florida Limited Liability | 2018-12-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
