| Entity Name: | BASSI MENTAL HEALTH PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Jan 2021 (4 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 26 Oct 2021 (3 years ago) |
| Document Number: | P21000019977 |
| FEI/EIN Number | 82-4049258 |
| Address: | 12058 SAN JOSE BLVD STE 202, JACKSONVILLE, FL, 32223 |
| Mail Address: | 1820 STATE ROAD 13, STE 11-926, JACKSONVILLE, FL, 32259 |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013425586 | 2018-01-17 | 2024-06-04 | 12058 SAN JOSE BLVD STE 202, JACKSONVILLE, FL, 322238669, US | 1820 STATE ROAD 13 N STE 11-926, ST JOHNS, FL, 322598856, US | |||||||||||||||||||
|
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| Phone | +1 888-730-5220 |
| Fax | 8885248166 |
Authorized person
| Name | DR. BRUCE DANIEL BASSI |
| Role | MEDICAL DIRECTOR |
| Phone | 8887305220 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME129546 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ANDERSON REGISTERED AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BASSI BRUCE | President | 1820 STATE ROAD 13 STE 11-926, SAINT JOHNS, FL, 322598856 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000019845 | TELEPSYCHHEALTH | ACTIVE | 2022-01-27 | 2027-12-31 | No data | 1820 SR 13, STE 11-926, ST JOHNS, FL, 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-07 | 12058 SAN JOSE BLVD STE 202, JACKSONVILLE, FL 32223 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-07 | 12058 SAN JOSE BLVD STE 202, JACKSONVILLE, FL 32223 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-07 | ANDERSON REGISTERED AGENTS, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-07 | 625 E. TWIGGS STREET, SUITE 110, TAMPA, FL 33602 | No data |
| AMENDMENT AND NAME CHANGE | 2021-10-26 | BASSI MENTAL HEALTH PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-01 |
| Reg. Agent Change | 2022-03-07 |
| Amendment and Name Change | 2021-10-26 |
| Domestic Profit | 2021-01-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
