| Entity Name: | KEYSTONE PSYCHOLOGICAL SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Jul 2021 (4 years ago) |
| Document Number: | L21000332638 |
| FEI/EIN Number | 88-1143984 |
| Address: | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 |
| Mail Address: | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 |
| ZIP code: | 34688 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750060604 | 2023-07-17 | 2023-07-17 | 155 E TARPON AVE STE 4, TARPON SPRINGS, FL, 346893451, US | 155 E TARPON AVE STE 4, TARPON SPRINGS, FL, 346893451, US | |||||||||||||||||||||
|
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| Phone | +1 727-275-0282 |
Authorized person
| Name | DR. MELINA SCALLY |
| Role | OWNER, LICENSED PSYCHOLOGIST |
| Phone | 7272750282 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SCALLY, MELINA, PSYD | Agent | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 |
| Name | Role | Address |
|---|---|---|
| Caramiello, Shannon, PSYD | Owner | 2611 Keystone Road, B3 Tarpon Springs, FL 34688 |
| Scally, Melina | Owner | 2611 Keystone Road, B3 Tarpon Springs, FL 34688 |
| Name | Role | Address |
|---|---|---|
| Caramiello, Shannon, PSYD | Operator | 2611 Keystone Road, B3 Tarpon Springs, FL 34688 |
| Scally, Melina | Operator | 2611 Keystone Road, B3 Tarpon Springs, FL 34688 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-30 | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-30 | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-30 | 2611 Keystone Road, B3, Tarpon Springs, FL 34688 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-03-10 |
| Florida Limited Liability | 2021-07-22 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
