| Entity Name: | ELIZABETH SOUTHARD, LMHC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 May 2020 (5 years ago) |
| Document Number: | L20000129164 |
| FEI/EIN Number | 85-2751031 |
| Address: | 690-A W MACCLENNY AVENUE, MACCLENNY, FL, 32063 |
| Mail Address: | 5570 HUCKLEBERRY TRL N, MACCLENNY, FL, 32063 |
| ZIP code: | 32063 |
| County: | Baker |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841802683 | 2020-08-22 | 2021-04-17 | 5570 HUCKLEBERRY TRL N, MACCLENNY, FL, 320631803, US | 690A W MACCLENNY AVE, MACCLENNY, FL, 320632080, US | |||||||||||||||||||||
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| Phone | +1 904-885-9948 |
| Phone | +1 904-400-0517 |
Authorized person
| Name | MRS. MARY ELIZABETH SOUTHARD |
| Role | OWNER |
| Phone | 9044000517 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021509900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SOUTHARD MARY ELMHC | Agent | 690-A W MACCLENNY AVENUE, MACCLENNY, FL, 32063 |
| Name | Role | Address |
|---|---|---|
| SOUTHARD MARY ELMHC | Manager | 690-A W MACCLENNY AVENUE, MACCLENNY, FL, 32063 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-20 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-17 |
| Florida Limited Liability | 2020-05-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
