| Entity Name: | PSYCHE MEDICAL GROUP PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Nov 2023 (a year ago) |
| Last Event: | LC STMNT CORR |
| Event Date Filed: | 07 Dec 2023 (a year ago) |
| Document Number: | L23000528121 |
| Address: | 501 EAST KENNEDY BOULEVARD, 14TH FLOOR, TAMPA, FL 33602 |
| Mail Address: | 501 EAST KENNEDY BOULEVARD, 14TH FLOOR, TAMPA, FL 33602 |
| ZIP code: | 33602 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902673155 | 2023-12-07 | 2023-12-07 | 501 E KENNEDY BLVD FL 14, TAMPA, FL, 336025237, US | 501 E KENNEDY BLVD FL 14, TAMPA, FL, 336025237, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 833-877-9243 |
| Fax | 8338779243 |
Authorized person
| Name | DR. BENJAMIN ORLANDO KLASS |
| Role | MANAGER |
| Phone | 8338779243 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 102L00000X - Psychoanalyst |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| KLASS, BENJAMIN O | Manager | 501 EAST KENNEDY BOULEVARD 14TH FLOOR, TAMPA, FL 33602 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT CORR | 2023-12-07 | No data | No data |
| Name | Date |
|---|---|
| CORLCSTCOR | 2023-12-07 |
| Florida Limited Liability | 2023-11-27 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
