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Mallorie Ely, LLC

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Company Details

Name: Mallorie Ely, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Dec 2019 (6 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 3695840
Place of Formation: IDAHO
File Number: 689551
ZIP code: 83864
County: Bonner County
Principal Address: 204 231 N 3RD SANDPOINT, ID 83864
Mailing Address: MALLORIE ELY PO BOX 484 KOOTENAI, ID 83840-0484

Agent

Name Role Address
Mallorie Ely Agent 1009 HWY 2 SUITE D, SANDPOINT, ID 83864

Manager

Name Role Address Appointed On
Mallorie Ely Manager PO BOX 484, KOOTENAI, ID 83840 2020-12-16

National Provider Identifier

NPI Number:
1649818642
Certification Date:
2023-08-08

Authorized Person:

Name:
MALLORIE ELY
Role:
OWNER/CLINICIAN
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006001235 2024-12-03
Annual Report 0005459309 2023-11-03
Annual Report 0005070656 2023-01-15
Annual Report 0004495511 2021-11-11
Annual Report 0004102388 2020-12-16

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State