| Entity Name: | KRISTEN DAVIDSON, PSY.D., PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Sep 2022 (2 years ago) |
| Document Number: | L22000404696 |
| FEI/EIN Number | 92-0417108 |
| Mail Address: | 13606 CASSIOPEIA DR, ORLANDO, FL, 32828, US |
| Address: | 2497 Waving Moss Way, Winter Park, FL, 32792, US |
| ZIP code: | 32792 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316790942 | 2024-04-11 | 2024-04-11 | 13606 CASSIOPEIA DR, ORLANDO, FL, 328289310, US | 2497 WAVING MOSS WAY, WINTER PARK, FL, 327923041, US | |||||||||||||||||||||
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| Phone | +1 405-315-3070 |
| Phone | +1 407-793-1282 |
| Fax | 8338951282 |
Authorized person
| Name | DR. KRISTEN MICHELLE DAVIDSON |
| Role | CLINICAL NEUROPSYCHOLOGIST |
| Phone | 4077931282 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DAVIDSON KRISTEN M | Agent | 13606 CASSIOPEIA DR, ORLANDO, FL, 32828 |
| Name | Role | Address |
|---|---|---|
| DAVIDSON KRISTEN | Authorized Member | 13606 CASSIOPEIA DR, ORLANDO, FL, 32828 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-19 | 2497 Waving Moss Way, Winter Park, FL 32792 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-08 |
| ANNUAL REPORT | 2023-04-19 |
| Florida Limited Liability | 2022-09-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
