| Entity Name: | SPACE COAST COUNSELING CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Aug 2005 (19 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Jun 2018 (7 years ago) |
| Document Number: | P05000119120 |
| FEI/EIN Number | 134308090 |
| Address: | 166 Center Street, Cape Canaveral, FL, 32920, US |
| Mail Address: | P.O. Box 1284, Cape Canaveral, FL, 32920-1284, US |
| ZIP code: | 32920 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316070345 | 2007-03-13 | 2022-06-17 | PO BOX 1284, CAPE CANAVERAL, FL, 329201284, US | 166 CENTER ST STE 239, CAPE CANAVERAL, FL, 329203717, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 321-267-2288 |
| Fax | 8667030035 |
Authorized person
| Name | MS. LANA LYNN BEASLEY |
| Role | PRESIDENT |
| Phone | 3212672228 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00493900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 113658100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Beasley Lana L | Agent | 166 Center Street, Cape Canaveral, FL, 32920 |
| Name | Role | Address |
|---|---|---|
| BEASLEY LANA L | President | 166 Center Street, Cape Canaveral, FL, 32920 |
| Name | Role | Address |
|---|---|---|
| Beasley Lana L | Director | P.O. Box 1284, Cape Canaveral, FL, 329201284 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-21 | 166 Center Street, Suite 239, Cape Canaveral, FL 32920 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-04-21 | Beasley, Lana Lynn | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-21 | 166 Center Street, Suite 239, Cape Canaveral, FL 32920 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-05 | 166 Center Street, Suite 239, Cape Canaveral, FL 32920 | No data |
| REINSTATEMENT | 2018-06-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| NAME CHANGE AMENDMENT | 2005-08-29 | SPACE COAST COUNSELING CENTER, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-03-30 |
| AMENDED ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-03-11 |
| ANNUAL REPORT | 2019-04-03 |
| REINSTATEMENT | 2018-06-13 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
