| Entity Name: | CENTRAL FLORIDA PSYCHOLOGICAL SERVICES, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Aug 2007 (18 years ago) |
| Date of dissolution: | 30 Sep 2013 (11 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Sep 2013 (11 years ago) |
| Document Number: | P07000088482 |
| FEI/EIN Number | 452152228 |
| Address: | 125 WEST PINEVIEW ST., SUITE 1005, ALTAMONTE SPRINGS, FL, 32714, US |
| Mail Address: | 914 KERSFIELD CR., LAKE MARY, FL, 32746, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265724033 | 2011-05-11 | 2011-11-30 | 125 W PINEVIEW ST, SUITE 1005, ALTAMONTE SPRINGS, FL, 327142007, US | 125 W PINEVIEW ST, SUITE 1005, ALTAMONTE SPRINGS, FL, 327142007, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 407-951-6920 |
Authorized person
| Name | DR. MARY T HOLCOMB |
| Role | PRESIDENT |
| Phone | 4073474676 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| License Number | PY0004613 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 59488 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Agent | 914 KERSFIELD CR., LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | President | 914 KERSFIELD CR., LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Treasurer | 914 KERSFIELD CR., LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Secretary | 914 KERSFIELD CR., LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| HOLCOMB MARY T | Director | 914 KERSFIELD CR., LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2013-09-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-16 | 125 WEST PINEVIEW ST., SUITE 1005, ALTAMONTE SPRINGS, FL 32714 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2013-09-30 |
| ANNUAL REPORT | 2012-04-16 |
| CHANGE FEIN# | 2011-05-31 |
| ANNUAL REPORT | 2011-05-01 |
| ANNUAL REPORT | 2010-05-02 |
| ANNUAL REPORT | 2009-04-25 |
| ANNUAL REPORT | 2008-05-06 |
| Domestic Profit | 2007-08-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
