| Entity Name: | ORIGIN PSYCHIATRY & COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Oct 2021 (3 years ago) |
| Document Number: | L21000444308 |
| FEI/EIN Number | 87-3158455 |
| Address: | 14520 MAIN ST, ALACHUA, FL, 32615 |
| Mail Address: | 802 TURKEY CREEK, ALACHUA, FL, 32615 |
| ZIP code: | 32615 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891512000 | 2024-09-20 | 2024-09-20 | 802 TURKEY CRK, ALACHUA, FL, 326159313, US | 14520 MAIN ST # 40, ALACHUA, FL, 326158592, US | |||||||||||||||||||
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| Phone | +1 813-738-4024 |
| Fax | 3523294372 |
Authorized person
| Name | ERIN DELANEY |
| Role | OWNER, PSYCH NP |
| Phone | 8137384024 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DELANEY ERIN M | Agent | 6925 NW 121ST AVE, ALACHUA, FL, 32615 |
| Name | Role | Address |
|---|---|---|
| DELANEY ERIN M | Authorized Member | 6925 NW 121ST AVE, ALACHUA, FL, 32615 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-19 |
| Florida Limited Liability | 2021-10-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
