| Entity Name: | SOUL SPARK THERAPY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Mar 2024 (a year ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 11 Jun 2024 (8 months ago) |
| Document Number: | L24000151645 |
| Address: | 1317 EDGEWATER DRIVE #1732, ORLANDO, FL 32804 |
| Mail Address: | 1317 EDGEWATER DRIVE #1732, ORLANDO, FL 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699512681 | 2024-07-09 | 2024-07-09 | 1317 EDGEWATER DR # 1732, ORLANDO, FL, 328046350, US | 140 SEPP RD, DEBARY, FL, 327133914, US | |||||||||||||||||||
|
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| Phone | +1 407-588-7244 |
Authorized person
| Name | MS. REBECCA RUH |
| Role | LICENSED MENTAL HEALTH COUNSELOR |
| Phone | 4075887244 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI TYPE 1 |
| Number | 1669236212 |
| State | FL |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| RUH, REBECCA | Authorized Member | 1317 EDGEWATER DRIVE #1732, ORLANDO, FL 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-06-11 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-11 | 1317 EDGEWATER DRIVE #1732, ORLANDO, FL 32804 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-11 | 1317 EDGEWATER DRIVE #1732, ORLANDO, FL 32804 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-06-11 | 7901 4TH ST N STE 300, ST. PETERSBURG, FL 33702 | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-06-11 |
| Florida Limited Liability | 2024-03-28 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
