| Entity Name: | PROFESSIONAL TRAINING ASSOCIATION CORPORATION |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 18 Sep 2000 (24 years ago) |
| Document Number: | N00000006241 |
| FEI/EIN Number | 651053847 |
| Address: | 141 NW 20TH ST, STE F-7, BOCA RATON, FL, 33431, US |
| Mail Address: | 141 NW 20TH ST, STE F-7, BOCA RATON, FL, 33431, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164663571 | 2009-03-13 | 2009-03-13 | 8358 W OAKLAND PARK BLVD, SUITE 302, SUNRISE, FL, 333517319, US | 8358 W OAKLAND PARK BLVD, SUITE 302, SUNRISE, FL, 333517319, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-816-7151 |
Authorized person
| Name | MISS JANINA GIRON |
| Role | DIRECTOR |
| Phone | 9548167151 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | BY7137 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TF0200X - Forensic Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 104100000X - Social Worker |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | APPLIED FOR |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STEIN LEE | Agent | 141 NW 20TH ST, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| Stein Lee S | Director | 321 NORTHLAKE BLVD, NORTH PALM BEACH, FL, 33408 |
| MAHLER DAVID | Director | 321 NOTHLAKE BLVD, NORTH PALM BEACH, FL, 33408 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| AMENDMENT | 2016-10-24 | No data | No data |
| AMENDMENT | 2015-07-24 | No data | No data |
| AMENDMENT | 2014-07-31 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000454761 | LAPSED | 502016CA001658XXXXMB | PALM BEACH COUNTY | 2017-02-24 | 2022-08-08 | $280,576.00 | BEHAVIORAL HEALTH SOLUTIONS, LLC, 2700 PGA BLVD, STE 203, PALM BEACH GARDENS, FL 33410 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
