| Entity Name: | EILEEN GUSTAFSON LCSW PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jan 2006 (19 years ago) |
| Document Number: | P06000000970 |
| FEI/EIN Number | 204102722 |
| Address: | 10347 Cross Creek Boulevard, Suite B, TAMPA, FL, 33647, US |
| Mail Address: | P.O. BOX 5797, SPRING HILL, FL, 34611 |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396933446 | 2007-10-12 | 2008-08-12 | PO BOX 5797, SPRING HILL, FL, 346115797, US | 10335 CROSS CREEK BLVD, SUITE 23, TAMPA, FL, 336472795, US | |||||||||||||||||||
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| Phone | +1 352-428-8463 |
| Fax | 3525972074 |
Authorized person
| Name | MS. EILEEN GUSTAFSON |
| Role | OWNER/THERAPIST |
| Phone | 3524288463 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | LCSW 6283 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GUSTAFSON EILEEN | Agent | 10347 Cross Creek Boulevard, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| GUSTAFSON EILEEN | Manager | 10347 Cross Creek Boulevard, Suite B, TAMPA, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-29 | 10347 Cross Creek Boulevard, Suite B, TAMPA, FL 33647 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-29 | 10347 Cross Creek Boulevard, Suite B, TAMPA, FL 33647 | No data |
| CHANGE OF MAILING ADDRESS | 2010-05-03 | 10347 Cross Creek Boulevard, Suite B, TAMPA, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
