| Entity Name: | BESPOKE PSYCHOTHERAPY SERVICES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Jun 2021 (4 years ago) |
| Document Number: | P21000052839 |
| FEI/EIN Number | 87-1033766 |
| Address: | 17595 SOUTH TAMIAMI TRAIL, Suite 210, FORT MYERS, FL, 33908, US |
| Mail Address: | 7420 Twin Eagle Lane, Fort Myers, FL, 33912, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659046852 | 2021-08-10 | 2022-12-09 | TODD A. BATTLES, LMHC, 17595 SOUTH TAMIAMI TRAIL, SUITE 210, FORT MYERS, FL, 339084884, US | 17595 S TAMIAMI TRL STE 210, FORT MYERS, FL, 339084889, US | |||||||||||||||||||
|
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| Phone | +1 239-310-2110 |
| Fax | 2393102111 |
Authorized person
| Name | MR. TODD A. BATTLES |
| Role | OWNER |
| Phone | 2393102110 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Douglas Tepper | Agent | 7420 Twin Eagle Lane, Fort Myers, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| BATTLES TODD A | President | 17595 SOUTH TAMIAMI TRAIL STE 210, FORT MYERS, FL, 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-17 | 17595 SOUTH TAMIAMI TRAIL, Suite 210, FORT MYERS, FL 33908 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-02-17 | Douglas, Tepper | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-17 | 7420 Twin Eagle Lane, Fort Myers, FL 33912 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-20 | 17595 SOUTH TAMIAMI TRAIL, Suite 210, FORT MYERS, FL 33908 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-20 |
| Domestic Profit | 2021-06-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
