| Entity Name: | PAWSITIVE PSYCHIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 20 Jan 2022 (3 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L22000034141 |
| Address: | 20394 GALILEO PL., VENICE, FL 34293 |
| Mail Address: | P.O. BOX 1254, 350 W. VENICE AVE., VENICE, FL 34285 |
| ZIP code: | 34293 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447905658 | 2022-02-16 | 2022-03-06 | 350 W VENICE AVE, VENICE, FL, 342850001, US | 20394 GALILEO PL, VENICE, FL, 342931579, US | |||||||||||||||||||||||||||||
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| Phone | +1 941-265-8306 |
| Fax | 9414621864 |
Authorized person
| Name | DENISE WHITE |
| Role | PMHNP-BC |
| Phone | 9415252766 |
Taxonomy
| 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 | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1477624294 |
| State | MA |
| Name | Role | Address |
|---|---|---|
| WHITE, DENISE | Agent | 20394 GALILEO PL., VENICE, FL 34293 |
| Name | Role | Address |
|---|---|---|
| WHITE, AMBER | Authorized Member | 20394 GALILEO PL., VENICE, FL 34293 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2022-01-20 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
