| Entity Name: | THE MINDFUL PRACTICE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Sep 2019 (5 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 22 Nov 2021 (3 years ago) |
| Document Number: | L19000239393 |
| FEI/EIN Number | 84-3195262 |
| Address: | 1133 LOUISIANA AVENUE, STE 106, Winter Park, FL 32789 |
| Mail Address: | 1133 LOUISIANA AVENUE, STE 106, Winter Park, FL 32789 |
| ZIP code: | 32789 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831858497 | 2021-12-10 | 2023-10-13 | 1133 LOUISIANA AVE STE 106, WINTER PARK, FL, 327892350, US | 1133 LOUISIANA AVE STE 106, WINTER PARK, FL, 327892350, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-308-2747 |
| Fax | 3214135886 |
Authorized person
| Name | ALEXIS PARDO |
| Role | PRESIDENT |
| Phone | 4073082747 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | LICENSE NUMBER |
| Number | SW16166 |
| State | FL |
| Issuer | NPI |
| Number | 1588163679 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE MINDFUL PRACTICE LLC 401(K) PLAN | 2023 | 843195262 | 2024-05-21 | THE MINDFUL PRACTICE LLC | 0 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-21 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| PARDO, ALEXIS | Agent | 1050 Aloma Avenue, Winter Park, FL 32789 |
| Name | Role | Address |
|---|---|---|
| PARDO, ALEXIS | Authorized Representative | 1133 LOUISIANA AVENUE, STE 106 Winter Park, FL 32789 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000053934 | THE MINDFUL PRACTICE | ACTIVE | 2024-04-23 | 2029-12-31 | No data | 1133 LOUISIANA AVENUE, SUITE106, WINTER PARK, FL, 32789 |
| G20000037621 | THE MINDFUL PRACTICE | ACTIVE | 2020-04-02 | 2025-12-31 | No data | 1177 LOUISIANA AVENUE, SUITE 204, WINTER PARK, FL, 32789 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-18 | 1133 LOUISIANA AVENUE, STE 106, Winter Park, FL 32789 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-18 | 1133 LOUISIANA AVENUE, STE 106, Winter Park, FL 32789 | No data |
| LC AMENDMENT AND NAME CHANGE | 2021-11-22 | THE MINDFUL PRACTICE, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-22 | 1050 Aloma Avenue, Winter Park, FL 32789 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-02-24 |
| LC Amendment and Name Change | 2021-11-22 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-03-15 |
| Florida Limited Liability | 2019-09-23 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
