| Entity Name: | BLOOMING BEHAVIOR THERAPY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Jun 2022 (3 years ago) |
| Document Number: | L22000282051 |
| FEI/EIN Number | 88-2931621 |
| Address: | 43 Barkley Cir, STE 101, FORT MYERS, FL 33907 |
| Mail Address: | 43 Barkley Cir, STE 101, FORT MYERS, FL 33907 |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427780402 | 2022-06-28 | 2024-09-09 | 43 BARKLEY CIR STE 101, FORT MYERS, FL, 339077517, US | 43 BARKLEY CIR STE 101, FORT MYERS, FL, 339077517, US | |||||||||||||||||||||||||||
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| Phone | +1 239-800-9289 |
Authorized person
| Name | ANA LAURA TRUJILLO |
| Role | OWNER |
| Phone | 8572471006 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 106E00000X - Assistant Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114740200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TRUJILLO GALVEZ, ANA L | Agent | 3 E CLERMONT CT, FORT MYERS, FL 33916 |
| Name | Role | Address |
|---|---|---|
| TRUJILLO GALVEZ, ANA L | Manager | 3 E CLERMONT CT, FORT MYERS, FL 33916 |
| Perez, Javier | Manager | 3620 Colonial Blvd, Suite 180 FORT MYERS, FL 33966 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-09 | 43 Barkley Cir, STE 101, FORT MYERS, FL 33907 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-09 | 43 Barkley Cir, STE 101, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-05 | 3 E CLERMONT CT, FORT MYERS, FL 33916 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-09-09 |
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-04-05 |
| Florida Limited Liability | 2022-06-21 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
