| Entity Name: | LUMOS MENTAL HEALTH PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Sep 2023 (a year ago) |
| Document Number: | L23000414033 |
| FEI/EIN Number | 93-3317955 |
| Address: | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 |
| Mail Address: | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 |
| ZIP code: | 33702 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457190126 | 2024-05-22 | 2024-05-22 | 7643 GATE PKWY STE 104-1381, JACKSONVILLE, FL, 322563092, US | 10151 DEERWOOD PARK BLVD BLDG 200, JACKSONVILLE, FL, 322560566, US | |||||||||||||||||
|
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| Phone | +1 904-906-6754 |
Authorized person
| Name | JULIE MARGARITA SMITH |
| Role | OWNER |
| Phone | 9043221232 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MY INDIVIDUAL NPI |
| Number | 1588160303 |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| Smith, Julie | Authorized Member | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-04-01 | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-01 | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-09 | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-02-09 | REGISTERED AGENTS INC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| Florida Limited Liability | 2023-09-06 |
Date of last update: 09 Jan 2025
Sources: Florida Department of State
