| Entity Name: | CRYSTAL MIND BEHAVIORAL INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 06 Jun 2024 (8 months ago) |
| Document Number: | P24000039377 |
| Mail Address: | 12130 SW 41ST DR, MIAMI, FL 33175 |
| Address: | 11900 BISCAYNE BLVD, # 410, NORTH MIAMI, FL 33181 |
| ZIP code: | 33181 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073343380 | 2024-08-02 | 2024-08-02 | 11890 SW 8TH ST STE 401, MIAMI, FL, 331841710, US | 11890 SW 8TH ST STE 401, MIAMI, FL, 331841710, US | |||||||||||||
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| Phone | +1 786-707-8599 |
Authorized person
| Name | GRETEL LOYOLA HERRERA |
| Role | AUTHORIZED OFFICIAL |
| Phone | 7867078599 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LOYOLA, GRETEL | Agent | 12130 SW 41ST DR, MIAMI, FL 33175 |
| Name | Role | Address |
|---|---|---|
| LOYOLA, GRETEL | President | 12130 SW 41ST DR, MIAMI, FL 33175 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ, JUNIOR | Vice President | 17890 SW 264TH ST, HOMESTEAD, FL 33031 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-06-06 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
