| Entity Name: | MELCOLM MENTAL HEALTH SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Dec 2022 (2 years ago) |
| Document Number: | L22000524193 |
| FEI/EIN Number | 88-4397480 |
| Address: | 4110 OSCEOLA TRL, MIDDLEBURG, FL, 32068, US |
| Mail Address: | 4110 OSCEOLA TRL, MIDDLEBURG, FL, 32068, US |
| ZIP code: | 32068 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396509865 | 2024-02-06 | 2024-02-06 | 4110 OSCEOLA TRL, MIDDLEBURG, FL, 320687149, US | 4110 OSCEOLA TRL, MIDDLEBURG, FL, 320687149, US | |||||||||||||
|
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| Phone | +1 904-502-9883 |
Authorized person
| Name | TABATHA MELCOLM |
| Role | OWNER |
| Phone | 9045029883 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MELCOLM TABATHA L | Authorized Member | 4110 OSCEOLA TRL, MIDDLEBURG, FL, 32068 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-04-07 |
| Florida Limited Liability | 2022-12-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
