| Entity Name: | GALAXY BEHAVIOR THERAPY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Aug 2016 (8 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 26 Jan 2024 (a year ago) |
| Document Number: | P16000070662 |
| FEI/EIN Number | 81-3678517 |
| Address: | 1013 Joel Blvd, LEHIGH ACRES, FL, 33936, US |
| Mail Address: | 1013 Joel Blvd, LEHIGH ACRES, FL, 33936, US |
| ZIP code: | 33936 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962949867 | 2017-01-30 | 2024-04-02 | 1013 JOEL BLVD, LEHIGH ACRES, FL, 339363265, US | 1013 JOEL BLVD, LEHIGH ACRES, FL, 339363265, US | |||||||||||||||||||||||||||||||
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| Phone | +1 786-317-0375 |
| Fax | 8555231291 |
Authorized person
| Name | GISSEL CHANG |
| Role | OWNER |
| Phone | 7863170375 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108848300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 018657300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHANG GISSEL | Agent | 808 GRANT AVE, LEHIGH ACRES, FL, 33972 |
| Name | Role | Address |
|---|---|---|
| CHANG GISSEL | President | 808 GRANT AVE, LEHIGH ACRES, FL, 33972 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000156205 | GALAXY HOMEMAKER AND COMPANION SERVICES | ACTIVE | 2024-12-26 | 2029-12-31 | No data | 1013 JOEL BLVD, LEHIGH ACRES, FL, 33936 |
| G22000037000 | GALAXY BEHAVIOR THERAPY | ACTIVE | 2022-03-22 | 2027-12-31 | No data | 808 GRANT AVE, LEHIGH ACRES, FL, 33972 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2024-01-26 | GALAXY BEHAVIOR THERAPY INC. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-19 | 1013 Joel Blvd, LEHIGH ACRES, FL 33936 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-19 | 1013 Joel Blvd, LEHIGH ACRES, FL 33936 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-30 | 808 GRANT AVE, LEHIGH ACRES, FL 33972 | No data |
| Name | Date |
|---|---|
| Name Change | 2024-01-26 |
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-02-26 |
| ANNUAL REPORT | 2017-09-02 |
| Domestic Profit | 2016-08-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
