| Entity Name: | BETH A. MEDINA, MS, LMHC, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Jan 2008 (17 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 22 Dec 2017 (7 years ago) |
| Document Number: | P08000008648 |
| FEI/EIN Number | 900342843 |
| Address: | 12724 Gran Bay Parkway, Suite 410, JACKSONVILLE, FL, 32258, US |
| Mail Address: | 12724 Gran Bay Parkway, Suite 410, JACKSONVILLE, FL, 32258, US |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033520481 | 2014-05-19 | 2019-04-16 | 13241 BARTRAM PARK BLVD, STE. 301, JACKSONVILLE, FL, 322585212, US | 13241 BARTRAM PARK BLVD, STE. 301, JACKSONVILLE, FL, 322585212, US | |||||||||||||||||||
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| Phone | +1 904-268-1696 |
| Fax | 8448643674 |
Authorized person
| Name | MS. BETH ANN MEDINA |
| Role | OWNER |
| Phone | 9042681696 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH6748 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MEDINA BETH A | Agent | 12724 Gran Bay Parkway, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| MEDINA BETH A | Manager | 12724 Gran Bay Parkway, JACKSONVILLE, FL, 32258 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000166441 | BETH A. WOMBOUGH | EXPIRED | 2009-10-19 | 2014-12-31 | No data | 10175 FORTUNE PARKWAY, #504, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-06 | 12724 Gran Bay Parkway, Suite 410, JACKSONVILLE, JACKSONVILLE, FL 32258 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-06 | 12724 Gran Bay Parkway, Suite 410, JACKSONVILLE, JACKSONVILLE, FL 32258 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-06 | 12724 Gran Bay Parkway, Suite 410, JACKSONVILLE, JACKSONVILLE, FL 32258 | No data |
| NAME CHANGE AMENDMENT | 2017-12-22 | BETH A. MEDINA, MS, LMHC, PA | No data |
| REGISTERED AGENT NAME CHANGED | 2012-01-06 | MEDINA, BETH A | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-01-13 |
| Name Change | 2017-12-22 |
| ANNUAL REPORT | 2017-01-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
