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Psychedelic Psych, PLLC

Company Details

Name: Psychedelic Psych, PLLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 07 Jul 2023 (2 years ago)
Organization Date: 07 Jul 2023 (2 years ago)
Last Annual Report: 18 Aug 2024 (10 months ago)
Managed By: Members
Organization Number: 1292841
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40353
City: Mount Sterling, Camargo, Mt Sterling
Primary County: Montgomery County
Principal Office: 601 Doe Run Dr, STE 4, Mt Sterling, KY 40353
Place of Formation: KENTUCKY

Organizer

Name Role
Shawnda Carter Organizer

Registered Agent

Name Role
Shawnda Carter Registered Agent

National Provider Identifier

NPI Number:
1932938115
Certification Date:
2024-07-28

Authorized Person:

Name:
SHAWNDA CARTER
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filings

Name File Date
Annual Report 2024-08-18
Registered Agent name/address change 2024-08-18
Principal Office Address Change 2024-08-18

Sources: Kentucky Secretary of State