| Entity Name: | MIAMI PSYCHOLOGY & HUMAN SERVICE COLLABORATIVE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Apr 2010 (15 years ago) |
| Document Number: | P10000030113 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 4110 NW 15TH AVE, MIAMI, FL, 33142, US |
| Mail Address: | PO BOX 370333, MIAMI, FL, 33137, US |
| ZIP code: | 33142 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811215866 | 2010-05-13 | 2014-09-09 | PO BOX 370333, MIAMI, FL, 331370333, US | 8201 PETERS RD STE 1000, PLANTATION, FL, 333243266, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-741-5628 |
| Fax | 3053971650 |
Authorized person
| Name | MISS NATASHA K NALLS |
| Role | CLINICAL DIRECTOR |
| Phone | 3057415628 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 101YP1600X - Pastoral Counselor |
| License Number | SW9577 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW9577 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| NALLS NATASHA K | Agent | 4110 NW 15th Ave, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| NALLS NATASHA K | President | 4110 NW 15th Ave, MIAMI, FL, 33142 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000047059 | MY TEETH WHITENING STORE.COM | ACTIVE | 2021-04-06 | 2026-12-31 | No data | PO BOX 370333, MIAMI, FL, 33137 |
| G10000110868 | MIAMI PSYCHOLOGY GROUP | EXPIRED | 2010-12-06 | 2015-12-31 | No data | 7100 BISCAYNE BLVD., #214, MIAMI, FL, 33138 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-05 | 4110 NW 15th Ave, MIAMI, FL 33142 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-07-29 | 4110 NW 15TH AVE, MIAMI, FL 33142 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-19 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-01-03 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-01-21 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
