| Entity Name: | HOLIDAY WHISENANT COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Aug 2021 (3 years ago) |
| Document Number: | L21000386652 |
| FEI/EIN Number | 87-2631837 |
| Address: | 1253 HOLLIDAY DRIVE, GULF BREEZE, FL 32563 |
| Mail Address: | 1253 HOLLIDAY DRIVE, GULF BREEZE, FL 32563 |
| ZIP code: | 32563 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063157246 | 2022-05-02 | 2022-11-10 | 1253 HOLLIDAY DR, GULF BREEZE, FL, 325632529, US | 1253 HOLLIDAY DR, GULF BREEZE, FL, 325632529, US | |||||||||||||||||||
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| Phone | +1 850-220-8339 |
Authorized person
| Name | HOLIDAY WHISENANT |
| Role | OWNER |
| Phone | 8502873574 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009555800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COVELL, SCOTT | Agent | 1941 SEVILLE DRIVE, PENSACOLA, FL 32503 |
| Name | Role | Address |
|---|---|---|
| WHISENANT, HOLIDAY | Authorized Member | 1253 HOLLIDAY DRIVE, GULF BREEZE, FL 32563 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000121847 | HOLIDAY WHISENANT COUNSELING | ACTIVE | 2021-09-16 | 2026-12-31 | No data | 1253 HOLLIDAY DRIVE, GULF BREEZE, FL, 32563 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-26 |
| Florida Limited Liability | 2021-08-30 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
