| Entity Name: | HEALTHY MINDS WELLNESS GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Apr 2022 (3 years ago) |
| Document Number: | L22000200900 |
| FEI/EIN Number | 88-1688492 |
| Address: | 10519 Bermuda isle Drive, Tampa, FL 33647 |
| Mail Address: | 10519 Bermuda Isle Drive, Tampa, FL 33647 |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851164644 | 2023-11-02 | 2023-11-02 | 10519 BERMUDA ISLE DR, TAMPA, FL, 336472721, US | 10025 W HILLSBOROUGH AVE, TAMPA, FL, 336153000, US | |||||||||||||||||||||||||
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| Phone | +1 813-607-4289 |
| Fax | 8132917529 |
Authorized person
| Name | PAOLA L KASENETZ |
| Role | OWNER |
| Phone | 8136074289 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 119486300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KASENETZ, PAOLA L | Agent | 10519 BERMUDA ISLE DRIVE, TAMPA, FL 33647 |
| Name | Role | Address |
|---|---|---|
| KASENETZ, PAOLA | Authorized Member | 10519 BERMUDA ISLE DRIVE, TAMPA, FL 33647 UN |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-01 | 10519 Bermuda isle Drive, Tampa, FL 33647 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-21 | 10519 Bermuda isle Drive, Tampa, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-21 |
| Florida Limited Liability | 2022-04-27 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
