| Entity Name: | PATRICIA S DIXON- PSYD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jun 2022 (3 years ago) |
| Document Number: | L22000255037 |
| FEI/EIN Number | 45-3200334 |
| Address: | 3440 97th Lane East, PALMETTO, FL, 34221, US |
| Mail Address: | 1303 10th Street East, PALMETTO, FL, 34221, US |
| ZIP code: | 34221 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790068344 | 2011-09-21 | 2011-09-21 | PO BOX 47918, ST PETERSBURG, FL, 337437918, US | 5348 1ST AVE N, ST PETERSBURG, FL, 337108106, US | |||||||||||||||||||||||
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| Phone | +1 727-322-6143 |
| Phone | +1 727-322-6123 |
Authorized person
| Name | DR. PATRICIA SHALENE DIXON |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 7273226123 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | PY8356 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1598046286 |
| Name | Role | Address |
|---|---|---|
| DIXON PATRICIA S | Agent | 1303 10th Street East, PALMETTO, FL, 34221 |
| Name | Role | Address |
|---|---|---|
| DIXON PATRICIA S | Director | 3440 97TH LANE EAST, PALMETTO, FL, 34221 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-01 | 1303 10th Street East, PALMETTO, FL 34221 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-12 | 3440 97th Lane East, PALMETTO, FL 34221 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-12 | 3440 97th Lane East, PALMETTO, FL 34221 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-03-14 |
| Florida Limited Liability | 2022-06-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
