| Entity Name: | FLORIDA PSYCHOTHERAPY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 01 Feb 2024 (a year ago) |
| Document Number: | L24000060152 |
| Address: | 3151 N. 52 AVE, HOLLYWOOD, FL 33021 |
| Mail Address: | 3151 N. 52 AVE, HOLLYWOOD, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730539941 | 2016-06-18 | 2016-06-18 | 3835 MISTY LANDING DR, VALRICO, FL, 335944802, US | 106 W WINDHORST RD, BRANDON, FL, 335102455, US | |||||||||||||||||||
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| Phone | +1 727-424-8423 |
| Phone | +1 813-373-9531 |
Authorized person
| Name | JOMON JOHN THEKKETHOTTIYIL |
| Role | MANAGER |
| Phone | 7274248423 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW10806 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SABRA, RICHARD B, ESQ | Agent | 4600 SHERIDAN ST, STE 300, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| SABRA, LAURIE N | Manager | 3151 N 52 AVE, HOLLYWOOD, FL 33021 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-02-01 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
