| Entity Name: | TRAVELING PSYCHOLOGIST, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jan 2022 (3 years ago) |
| Document Number: | L22000045521 |
| FEI/EIN Number | 87-4043217 |
| Address: | 9214 NW 24TH LANE, GAINESVILLE, FL, 32606 |
| Mail Address: | 9214 NW 24TH LANE, GAINESVILLE, FL, 32606 |
| ZIP code: | 32606 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134876048 | 2022-03-10 | 2022-03-10 | 9214 NW 24TH LN, GAINESVILLE, FL, 326069143, US | 9214 NW 24TH LN, GAINESVILLE, FL, 326069143, US | |||||||||||||||||||
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| Phone | +1 352-281-8526 |
Authorized person
| Name | DR. KHALIL SAKALLA |
| Role | PSYCHOLOGIST |
| Phone | 3522818526 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | PY7142 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAKALLA KHALIL | Agent | 9214 NW 24TH LANE, GAINESVILLE, FL, 32606 |
| Name | Role | Address |
|---|---|---|
| SAKALLA KHALIL | Manager | 9214 NW 24TH LANE, GAINESVILLE, FL, 32606 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-30 |
| Florida Limited Liability | 2022-01-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
