| Entity Name: | EVOLVE BEHAVIORAL MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Nov 2020 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 03 Oct 2021 (3 years ago) |
| Document Number: | L20000350578 |
| FEI/EIN Number | 85-4021430 |
| Address: | 8348 LITTLE ROAD, PMB 138, NEW PORT RICHEY, FL, 34654 |
| Mail Address: | 8348 LITTLE ROAD, PMB 138, NEW PORT RICHEY, FL, 34654 |
| ZIP code: | 34654 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982472049 | 2023-12-18 | 2023-12-18 | 8348 LITTLE RD, PMB 138, NEW PORT RICHEY, FL, 346546358, US | 16614 N DALE MABRY HWY, TAMPA, FL, 336181400, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-384-8521 |
| Fax | 8136782768 |
Authorized person
| Name | DR. CUONG TON |
| Role | OWNER/MEDICAL DIRECTOR |
| Phone | 8133848521 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 251V00000X - Voluntary or Charitable Agency |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1100X - Research Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| TON CUONG T | Agent | 8348 LITTLE ROAD, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| TON CUONG T | Authorized Representative | PMB 138, 8348 LITTLE ROAD, NEW PORT RICHEY, FL, 35654 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-10-03 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-10-03 | TON, CUONG T | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-07-21 |
| REINSTATEMENT | 2021-10-03 |
| Florida Limited Liability | 2020-11-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
