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MINDESCAPE LLC - Florida Company Profile

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Company Details

Entity Name: MINDESCAPE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 16 Jul 2024 (a year ago)
Document Number: L24000315953
FEI/EIN Number NOT APPLICABLE
Address: 27911 CROWN LAKE BOULEVARD, SUITE 200, BONITA SPRINGS, FL, 34135
Mail Address: 27911 CROWN LAKE BOULEVARD, SUITE 200, BONITA SPRINGS, FL, 34135, UN
ZIP code: 34135
City: Bonita Springs
County: Lee
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MILLARD MAVELYN Owne 27911 CROWN LAKE BOULEVARD, BONITA SPRINGS, FL, 34135
Davis Audra C Prov 27911 Crown Lake Blvd, Bonita Springs, FL, 34135
Millard Mavelyn Agent 27911 CROWN LAKE BOULEVARD, BONITA SPRINGS, FL, 34135

National Provider Identifier

NPI Number:
1760216915
Certification Date:
2025-06-17

Authorized Person:

Name:
MARINA CHITOROGA
Role:
CLINICAL MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
103K00000X - Behavior Analyst
Is Primary:
Yes

Contacts:

Fax:
8009613367

Documents

Name Date
Florida Limited Liability 2024-07-16

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Date of last update: 02 Aug 2025

Sources: Florida Department of State