| Entity Name: | PROFICIENT INTEGRATION MENTAL HEALTH LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Apr 2021 (4 years ago) |
| Document Number: | L21000182984 |
| FEI/EIN Number | 86-3547116 |
| Address: | 911 S PARSONS AVENUE,, BRANDON, FL, 33511, US |
| Mail Address: | 911 S PARSONS AVENUE,, BRANDON, FL, 33511, US |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659042117 | 2021-09-24 | 2023-06-12 | 14819 CRESCENT ROCK DR, WIMAUMA, FL, 335986196, US | 911 S PARSONS AVE STE D, BRANDON, FL, 335116042, US | |||||||||||||||||
|
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| Phone | +1 469-216-4017 |
| Phone | +1 813-922-8240 |
| Fax | 8559412554 |
Authorized person
| Name | CAMILLE Y TURNER- SNAGG |
| Role | OWNER |
| Phone | 4692164017 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TURNER CAMILLE | Agent | 14819 CRESCENT ROCK DR, WIMAUMA, FL, 33598 |
| Name | Role | Address |
|---|---|---|
| TURNER CAMILLE | Manager | 14819 CRESCENT ROCK DR, WIMAUMA, FL, 33598 |
| Name | Role | Address |
|---|---|---|
| Snagg Kenneth | Oper | 14819 CRESCENT ROCK DR, WIMAUMA, FL, 33598 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000120569 | PIMHEALTH | ACTIVE | 2022-09-22 | 2027-12-31 | No data | 911 S PARSON AVENUE,SUITE D, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-08 | 911 S PARSONS AVENUE,, Suite D, BRANDON, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-08 | 911 S PARSONS AVENUE,, Suite D, BRANDON, FL 33511 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-01-29 |
| Florida Limited Liability | 2021-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
