| Entity Name: | GRACE PSYCHOLOGICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Nov 2022 (2 years ago) |
| Document Number: | L22000499324 |
| FEI/EIN Number | 92-1197965 |
| Address: | 12360 66th Street N, B1, largo, FL 33773 |
| Mail Address: | 12360 66th Street N, B1, largo, FL 33773 |
| ZIP code: | 33773 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982316303 | 2022-12-16 | 2023-01-29 | 1913 TYRONE BLVD N, ST PETERSBURG, FL, 337104841, US | 1913 TYRONE BLVD N, ST PETERSBURG, FL, 337104841, US | |||||||||||||||||||||
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| Phone | +1 727-314-2560 |
Authorized person
| Name | DR. ROBERTO ALVES |
| Role | MANAGER |
| Phone | 7273145001 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 593Q2 |
| Issuer | CIGNA |
| Number | 3963857 |
| Name | Role | Address |
|---|---|---|
| ALVES, ROBERTO | Agent | 12360 66th Street North, B1, Largo, FL 33773 |
| Name | Role | Address |
|---|---|---|
| Alves, Roberto | Manager | 12360 66th Street North, B1 Largo, FL 33773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-19 | 12360 66th Street North, B1, Largo, FL 33773 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-20 | 12360 66th Street N, B1, largo, FL 33773 | No data |
| CHANGE OF MAILING ADDRESS | 2023-06-20 | 12360 66th Street N, B1, largo, FL 33773 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-03-22 |
| Florida Limited Liability | 2022-11-28 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
