| Entity Name: | JILL A. SELBACH, PH.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Jun 2002 (23 years ago) |
| Document Number: | P02000071559 |
| FEI/EIN Number | 020628770 |
| Address: | 2811 NE 39th Ct, LIGHTHOUSE POINT, FL, 33064, US |
| Mail Address: | 2811 NE 39th Court, LIGHTHOUSE POINT, FL, 33064, US |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598033573 | 2011-12-06 | 2011-12-06 | 3650 N FEDERAL HWY, 215, LIGHTHOUSE POINT, FL, 330646649, US | 3650 N FEDERAL HWY, 215, LIGHTHOUSE POINT, FL, 330646649, US | |||||||||||||||||||
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| Phone | +1 954-618-8412 |
| Fax | 9547828389 |
Authorized person
| Name | DR. JILL ANN SELBACH |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 9546188412 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | PY6375 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| O'CONNOR TERRENCE P | Agent | 111 SE 12 ST, STE C, FT LAUDERDALE, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| SELBACH JILL A | Director | 2811 NE 39 CT, LIGHTHOUSE POINT, FL, 33064 |
| SELBACH JAMES P | Director | 2811 NE 39 CT, LIGHTHOUSE POINT, FL, 33064 |
| Name | Role | Address |
|---|---|---|
| SELBACH JAMES P | Vice President | 2811 NE 39 CT, LIGHTHOUSE POINT, FL, 33064 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-20 | 2811 NE 39th Ct, LIGHTHOUSE POINT, FL 33064 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-23 | 2811 NE 39th Ct, LIGHTHOUSE POINT, FL 33064 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-02-23 |
| ANNUAL REPORT | 2020-03-20 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-03-09 |
| ANNUAL REPORT | 2015-02-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
