| Entity Name: | BEHAVIORAL MIND WELLNESS: EVALUATION, PREVENTION & TREATMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Company
BEHAVIORAL MIND WELLNESS: EVALUATION, PREVENTION & TREATMENT, 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 19 Aug 2019 (6 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 01 Mar 2024 (a year ago) |
| Document Number: | L19000210399 |
| FEI/EIN Number |
84-3694317
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 417 W. VINE STREET, KISSIMMEE, FL 34741 |
| Mail Address: | 417 W. VINE STREET, KISSIMMEE, FL 34741 |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902432339 | 2020-03-17 | 2021-11-04 | 417 W VINE ST, KISSIMMEE, FL, 347414154, US | 417 W VINE ST, KISSIMMEE, FL, 347414154, US | |||||||||||||||||||||
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| Phone | +1 321-888-6965 |
| Fax | 4079786520 |
Authorized person
| Name | DR. CARMEN C CAPELLA |
| Role | LICENSED CLINICAL PSYCHOLOGIST |
| Phone | 3218886965 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024947100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ESTEVEZ, ANDREA, DR. | Agent | 2516 BROSS DRIVE, SAINT CLOUD, FL 34771 |
| CAPELLA, CARMEN C, DR. | Authorized Member | 2516 BROSS DRIVE, SAINT CLOUD, FL 34771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-01 | 2516 BROSS DRIVE, SAINT CLOUD, FL 34771 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-01 | 417 W. VINE STREET, KISSIMMEE, FL 34741 | - |
| CHANGE OF MAILING ADDRESS | 2024-03-01 | 417 W. VINE STREET, KISSIMMEE, FL 34741 | - |
| REGISTERED AGENT NAME CHANGED | 2024-03-01 | ESTEVEZ, ANDREA, DR. | - |
| LC STMNT OF RA/RO CHG | 2024-03-01 | - | - |
| LC AMENDMENT | 2022-05-31 | - | - |
| LC AMENDMENT | 2020-12-21 | - | - |
| LC AMENDMENT | 2019-10-09 | - | - |
| Name | Date |
|---|---|
| CORLCRACHG | 2024-03-01 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-30 |
| LC Amendment | 2022-05-31 |
| ANNUAL REPORT | 2022-03-13 |
| ANNUAL REPORT | 2021-02-02 |
| LC Amendment | 2020-12-21 |
| ANNUAL REPORT | 2020-05-24 |
| LC Amendment | 2019-10-09 |
| Florida Limited Liability | 2019-08-19 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
