| Entity Name: | GULFSHORE BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Jul 2019 (6 years ago) |
| Document Number: | L19000178093 |
| FEI/EIN Number | 84-2347143 |
| Address: | 1555 MATTHEW DRIVE, FORT MYERS, FL, 33907, US |
| Mail Address: | 1555 MATTHEW DRIVE, FORT MYERS, FL, 33907, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144877424 | 2019-08-21 | 2023-11-12 | 1555 MATTHEW DR, FORT MYERS, FL, 339071734, US | 1555 MATTHEW DR, FORT MYERS, FL, 339071734, US | |||||||||||||||||||||||||
|
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| Phone | +1 239-533-9860 |
Authorized person
| Name | DR. SAMANTHA DENBOER |
| Role | OWNER, LICENSED PSYCHOLOGIST |
| Phone | 2395339860 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DENBOER SAMANTHA DR. | Agent | 1555 MATTHEW DRIVE, FORT MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| DENBOER SAMANTHA DR. | President | 1555 MATTHEW DRIVE, FORT MYERS, FL, 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-03 | DENBOER, SAMANTHA, DR. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-16 | 1555 MATTHEW DRIVE, FORT MYERS, FL 33907 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-16 | 1555 MATTHEW DRIVE, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-16 | 1555 MATTHEW DRIVE, FORT MYERS, FL 33907 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-05-13 |
| Florida Limited Liability | 2019-07-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
