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PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC. - Florida Company Profile

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Company Details

Entity Name: PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 08 Mar 2018 (7 years ago)
Document Number: P18000022863
FEI/EIN Number 83-4141335
Address: 5818 SE AGNEW RD, BELLEVIEW, FL, 34420, US
Mail Address: 5818 SE AGNEW RD, BELLEVIEW, FL, 34420, US
ZIP code: 34420
City: Belleview
County: Marion
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
WOLLER NICOLE President 5818 SE AGNEW RD, BELLEVIEW, FL, 34420
WOLLER NIKKI Agent 5818 SE AGNEW RD, BELLEVIEW, FL, 34420

National Provider Identifier

NPI Number:
1174385470
Certification Date:
2024-03-20

Authorized Person:

Name:
DR. NICOLE WOLLER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QM0855X - Adolescent and Children Mental Health Clinic/Center
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000047493 PEDIATRIC BEHAVIORAL HEALTH INSTITUTE ACTIVE 2025-04-07 2030-12-31 - 5818 SE AGNEW ROAD, BELLEVIEW, FL, 34421
G19000039279 PEDIATRIC BEHAVIORAL HEALTH INSTITUTE OF MARION COUNTY EXPIRED 2019-03-26 2024-12-31 - 2735 SE 140 PL, SUMMERFIELD, FL, 34491

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2020-06-28 5818 SE AGNEW RD, BELLEVIEW, FL 34420 -
CHANGE OF MAILING ADDRESS 2020-06-28 5818 SE AGNEW RD, BELLEVIEW, FL 34420 -
REGISTERED AGENT ADDRESS CHANGED 2020-06-28 5818 SE AGNEW RD, BELLEVIEW, FL 34420 -

Documents

Name Date
ANNUAL REPORT 2024-04-19
ANNUAL REPORT 2023-04-19
ANNUAL REPORT 2022-04-16
ANNUAL REPORT 2021-04-28
ANNUAL REPORT 2020-06-28
ANNUAL REPORT 2019-04-30
Domestic Profit 2018-03-08

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Date of last update: 02 Aug 2025

Sources: Florida Department of State