| Entity Name: | COASTAL BEHAVIORAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jan 2019 (6 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 12 Apr 2021 (4 years ago) |
| Document Number: | L19000027760 |
| FEI/EIN Number | 83-4360066 |
| Address: | 10135 Montague Street, TAMPA, FL, 33626, US |
| Mail Address: | 10135 Montague Street, TAMPA, FL, 33626, US |
| ZIP code: | 33626 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598345514 | 2021-04-13 | 2021-04-16 | 10135 MONTAGUE ST, TAMPA, FL, 336261857, US | 10135 MONTAGUE ST, TAMPA, FL, 336261857, US | |||||||||||||
|
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| Phone | +1 813-401-2539 |
Authorized person
| Name | CRYSTAL LAGOR |
| Role | OWNER |
| Phone | 8134012539 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LAGOR CRYSTAL A | Agent | 10135 Montague Street, TAMPA, FL, 33626 |
| Name | Role | Address |
|---|---|---|
| LAGOR CRYSTAL A | Manager | 10135 Montague Street, TAMPA, FL, 33626 |
| Wixon Richard EJr. | Manager | 1482 Premier Village Way, Clearwater, FL, 33764 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-04-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-09 | 10135 Montague Street, TAMPA, FL 33626 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-09 | 10135 Montague Street, TAMPA, FL 33626 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-09 | 10135 Montague Street, TAMPA, FL 33626 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-28 |
| AMENDED ANNUAL REPORT | 2021-04-29 |
| LC Amendment | 2021-04-12 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-01-30 |
| Florida Limited Liability | 2019-01-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
