| Entity Name: | ANDREA MCCRARY, PSYCHOTHERAPIST, LMHC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Oct 2017 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 Oct 2019 (5 years ago) |
| Document Number: | P17000087393 |
| FEI/EIN Number | 82-3553396 |
| Address: | 9236 north Holland road, Panama City, FL, 32409, US |
| Mail Address: | 9236 north Holland road, Panama City, FL, 32409, US |
| ZIP code: | 32409 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588172209 | 2018-01-16 | 2018-01-16 | 203A FOREST PARK CIR, PANAMA CITY, FL, 324054916, US | 203A FOREST PARK CIR, PANAMA CITY, FL, 324054916, US | |||||||||||||||||||||||||
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| Phone | +1 850-348-7448 |
| Fax | 8885035896 |
Authorized person
| Name | ANDREA MCCRARY |
| Role | LMHC |
| Phone | 8503487448 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH11486 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016654600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCCRARY ANDREA | Agent | 9236 north Holland road, Panama City, FL, 32409 |
| Name | Role | Address |
|---|---|---|
| MCCRARY ANDREA | President | 9236 north Holland road, Panama City, FL, 32409 |
| Name | Role | Address |
|---|---|---|
| MCCRARY ANDREA | Vice President | 9236 north Holland road, Panama City, FL, 32409 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-10-11 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-10-11 | 9236 north Holland road, Panama City, FL 32409 | No data |
| CHANGE OF MAILING ADDRESS | 2019-10-11 | 9236 north Holland road, Panama City, FL 32409 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-11 | MCCRARY, ANDREA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-10-11 | 9236 north Holland road, Panama City, FL 32409 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-05-29 |
| REINSTATEMENT | 2019-10-11 |
| ANNUAL REPORT | 2018-09-21 |
| Domestic Profit | 2017-10-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
