| Entity Name: | HOLISTIC COACHING TREATMENT CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 May 2020 (5 years ago) |
| Document Number: | L20000132204 |
| FEI/EIN Number | 83-0819181 |
| Address: | 3135 1ST AVE N, 16942, St Petersburg, FL, 33733, US |
| Mail Address: | 3135 1ST AVE N, 16942, ST PETERSBURG, FL, 33733, US |
| ZIP code: | 33733 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992286900 | 2018-08-27 | 2018-08-27 | 3510 1ST AVE S # 226, ST PETERSBURG, FL, 337111304, US | 3510 1ST AVE S # 226, ST PETERSBURG, FL, 337111304, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-678-1751 |
Authorized person
| Name | MRS. JANNET T HARPER |
| Role | EXECUTIVE DIRECTOR OF PROGRAMMING |
| Phone | 7276781751 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| License Number | ISW11776 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | ISW11776 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | MH7947 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | ME106165 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2084P0802X - Addiction Psychiatry Physician |
| License Number | ME106165 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ARNP9400491 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 320800000X - Mental Illness Community Based Residential Treatment Facility |
| License Number | ISW11776 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| License Number | ISW11776 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363LC1500X - Community Health Nurse Practitioner |
| License Number | ARNP9400491 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 364S00000X - Clinical Nurse Specialist |
| License Number | ARNP9400491 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1063865608 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1871048314 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1346559820 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1407055171 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARPER JANNET T | Agent | 3510 1ST AVE N, ST PETERSBURG, FL, 33713 |
| Name | Role | Address |
|---|---|---|
| HARPER JANNET T | Manager | 3510 1ST AVE N, ST PETERSBURG, FL, 33713 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-08 | 3135 1ST AVE N, 16942, St Petersburg, FL 33733 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-08 | 3135 1ST AVE N, 16942, St Petersburg, FL 33733 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-03-19 |
| Florida Limited Liability | 2020-05-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
