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JACKSON BEHAVIORAL HEALTH PROFESSIONALS PLLC

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Company Details

Name: JACKSON BEHAVIORAL HEALTH PROFESSIONALS PLLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 26 Feb 2001 (24 years ago)
Organization Date: 26 Feb 2001 (24 years ago)
Last Annual Report: 10 Sep 2013 (12 years ago)
Managed By: Members
Organization Number: 0511316
ZIP code: 40701
City: Corbin, Keavy, Woodbine
Primary County: Whitley County
Principal Office: 34 SPURLOCK HETON AVE, CORBIN, KY 40701
Place of Formation: KENTUCKY

Registered Agent

Name Role
WILLIAM MATT ELLISON Registered Agent

Member

Name Role
William Ellison Member
Theresa Ellison Member

Organizer

Name Role
DOMENICK CAPOBIANCO Organizer
WILLIAM MATT WILSON Organizer

Signature

Name Role
WILLIAM ELLISON Signature

National Provider Identifier

NPI Number:
1336213784

Authorized Person:

Name:
MR. WILLIAM MATT ELLISON
Role:
PROPRIETOR
Phone:

Taxonomy:

Selected Taxonomy:
101YA0400X - Addiction (Substance Use Disorder) Counselor
Is Primary:
No
Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No

Contacts:

Fax:
6065268080

Filings

Name File Date
Administrative Dissolution 2014-09-30
Sixty Day Notice Return 2014-08-07
Annual Report 2013-09-10
Sixty Day Notice Return 2013-08-15
Annual Report 2012-04-19

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Sources: Kentucky Secretary of State