| Entity Name: | THE THERAPY ROOM MIND HEALTH AND WELLNESS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 May 2020 (5 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 07 Apr 2022 (3 years ago) |
| Document Number: | L20000145711 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 2581 Huntcliff Rd., PANAMA CITY, FL, 32405, US |
| Mail Address: | 3443 S. College Ave., Inverness, FL, 34452, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073120432 | 2020-09-29 | 2024-03-22 | 2581 HUNTCLIFF LN, PANAMA CITY, FL, 324054902, US | 2581 HUNTCLIFF LN, PANAMA CITY, FL, 324054902, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 850-520-3321 |
| Fax | 8508486490 |
Authorized person
| Name | KATIE BERGMAN |
| Role | OWNER |
| Phone | 3523626141 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110722500 |
| State | FL |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BERGMAN KATIE C | Authorized Member | 3443 S. College Ave., Inverness, FL, 34452 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-12 | 2581 Huntcliff Rd., PANAMA CITY, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-12 | 2581 Huntcliff Rd., PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-18 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| LC AMENDMENT AND NAME CHANGE | 2022-04-07 | THE THERAPY ROOM MIND HEALTH AND WELLNESS LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-04-12 |
| LC Amendment and Name Change | 2022-04-07 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-04-23 |
| Florida Limited Liability | 2020-05-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
