| Entity Name: | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Sep 2000 (24 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 04 Jan 2010 (15 years ago) |
| Document Number: | P00000090190 |
| FEI/EIN Number | 593672109 |
| Address: | 5300 S. Florida Avenue, Suite 4, LAKELAND, FL, 33813, US |
| Mail Address: | 5300 S. Florida Avenue, Suite 4, LAKELAND, FL, 33813, US |
| ZIP code: | 33813 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528127081 | 2006-12-08 | 2008-06-05 | 4720 CLEVELAND HEIGHTS BLVD, SUITE 105, LAKELAND, FL, 338132243, US | 4720 CLEVELAND HEIGHTS BLVD, SUITE 105, LAKELAND, FL, 338132243, US | |||||||||||||||
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| Phone | +1 863-701-9202 |
| Fax | 8637019262 |
Authorized person
| Name | TRACEY G. HENLEY |
| Role | PRESIDENT |
| Phone | 8637019202 |
Taxonomy
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. 401K RETIREMENT PLAN AND TRUST | 2023 | 593672109 | 2024-03-26 | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. | 3 | |||||||||||||
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| PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. 401K RETIREMENT PLAN AND TRUST | 2022 | 593672109 | 2023-02-14 | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. | 3 | |||||||||||||
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| PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. 401K RETIREMENT PLAN AND TRUST | 2021 | 593672109 | 2022-04-26 | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. | 4 | |||||||||||||
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| PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. 401K RETIREMENT PLAN AND TRUST | 2020 | 593672109 | 2021-06-18 | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. | 3 | |||||||||||||
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| PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. 401K RETIREMENT PLAN AND TRUST | 2019 | 593672109 | 2020-07-15 | PSYCHOLOGICAL AND NEUROBEHAVIORAL SERVICES, P.A. | 0 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| HENLEY, JR. BILL | Agent | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| HENLEY BILL J | Vice President | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| HENLEY BILL J | Secretary | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| HENLEY BILL J | Director | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| HENLEY BILL J | Treasurer | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| HENLEY TRACEY G | President | 5300 S. Florida Avenue, LAKELAND, FL, 33813 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G00304900393 | TRACEY G. HENLEY, PSY.D. | ACTIVE | 2000-10-29 | 2025-12-31 | No data | 5300 S. FLORIDA AVENUE, SUITE 4, LAKELAND, FL, 33813 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-02 | 5300 S. Florida Avenue, Suite 4, LAKELAND, FL 33813 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-02 | 5300 S. Florida Avenue, Suite 4, LAKELAND, FL 33813 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-02 | 5300 S. Florida Avenue, Suite 4, LAKELAND, FL 33813 | No data |
| CANCEL ADM DISS/REV | 2010-01-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| AMENDMENT | 2007-12-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2000-11-01 | HENLEY, JR., BILL | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-05-11 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-04-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
