| Entity Name: | EMDR TRAUMA THERAPY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Jul 2020 (5 years ago) |
| Document Number: | L20000199241 |
| FEI/EIN Number | 85-1887718 |
| Address: | 4609 US Highway 17, STE 1, FLEMING ISLAND, FL, 32003, US |
| Mail Address: | 1478 Rush LN, FLEMING ISLAND, FL, 32003, US |
| ZIP code: | 32003 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407474943 | 2020-07-10 | 2020-07-10 | 1543 KINGSLEY AVE STE 14, ORANGE PARK, FL, 320734570, US | 1543 KINGSLEY AVE STE 14, ORANGE PARK, FL, 320734570, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-710-7994 |
| Fax | 9042690870 |
| Phone | +1 904-375-9679 |
Authorized person
| Name | MRS. JEANNIE L MITCHELL |
| Role | PRINCIPLE/OWNER |
| Phone | 9043759679 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1114348661 |
| Name | Role | Address |
|---|---|---|
| MITCHELL JEANNIE L | Agent | 1478 Rush LN, FLEMING ISLAND, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| MITCHELL JEANNIE L | Authorized Member | 1478 Rush LN, FLEMING ISLAND, FL, 32003 |
| MITCHELL GUY TJR | Authorized Member | 1478 Rush LN, FLEMING ISLAND, FL, 32003 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000087880 | EMDR TT | ACTIVE | 2020-07-24 | 2025-12-31 | No data | 1543 KINGSLEY AVE, STE 14, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-01-09 | 4609 US Highway 17, STE 1, FLEMING ISLAND, FL 32003 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-09 | 1478 Rush LN, FLEMING ISLAND, FL 32003 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-02 | 4609 US Highway 17, STE 1, FLEMING ISLAND, FL 32003 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-02-02 |
| Florida Limited Liability | 2020-07-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
