| Entity Name: | SOUTHLAKE AUTISM AND BEHAVIOR SERVICES, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Jun 2011 (14 years ago) |
| Document Number: | P11000051882 |
| FEI/EIN Number | 452087951 |
| Address: | 350 ACCEPTANCE WAY, CLERMONT, FL, 34711, US |
| Mail Address: | 13201 SUGARBLUFF ROAD, CLERMONT, FL, 34715, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396017414 | 2012-02-05 | 2021-05-05 | 13201 SUGARBLUFF RD, CLERMONT, FL, 347156819, US | 350 ACCEPTANCE WAY, CLERMONT, FL, 34711, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-978-5903 |
| Fax | 3526003119 |
| Phone | +1 352-223-1999 |
Authorized person
| Name | MRS. TERRI HOWARD |
| Role | CLINICAL DIRECTOR/BEHAVIOR ANALYST |
| Phone | 3522231999 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| License Number | 0-11-4087 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| License Number | 0-11-4087 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 0-11-4087 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| License Number | 0-11-4087 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 0-11-4087 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HOWARD TERRI | Agent | 13201 SUGARBLUFF ROAD, CLERMONT, FL, 34715 |
| Name | Role | Address |
|---|---|---|
| HOWARD TERRI | President | 13201 SUGARBLUFF ROAD, CLERMONT, FL, 34715 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000091345 | SOUTHLAKE AUTISM | ACTIVE | 2015-09-04 | 2025-12-31 | No data | 13201 SUGARBLUFF RD, CLERMONT, FL, 34715 |
| G15000086057 | SOUTHLAKE AUTISM AND BEHAVIOR SERVICES | ACTIVE | 2015-08-20 | 2025-12-31 | No data | 13201 SUGARBLUFF RD, CLERMONT, FL, 34711--650 |
| G14000025592 | APPLIED BEHAVIOR EDUCATION AND LIFE SKILLS ACADEMY | ACTIVE | 2014-03-12 | 2029-12-31 | No data | 13201 SUGARBLUFF RD, CLERMONT, FL, 34715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-05 | HOWARD, TERRI | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-12-07 | 350 ACCEPTANCE WAY, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2017-11-27 | 350 ACCEPTANCE WAY, CLERMONT, FL 34711 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-11-21 | 13201 SUGARBLUFF ROAD, CLERMONT, FL 34715 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-01-15 |
| Reg. Agent Change | 2017-11-21 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
