| Name: | Headwaters Mental Health PLLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Active-Existing |
| Date of registration: | 19 Dec 2019 (5 years ago) |
| Financial Date End: | 31 Dec 2024 |
| Entity Number: | 3712971 |
| Place of Formation: | IDAHO |
| File Number: | 691779 |
| ZIP code: | 83703 |
| County: | Ada County |
| Principal Address: | GAYLE MATSUMURO 3961 N TAMARACK DR BOISE, ID 83703 |
| Mailing Address: | GAYLE MATSUMURO 3961 N TAMARACK DR BOISE, ID 83703-3930 |
| Name | Role | Address |
|---|---|---|
| Gayle Matsumuro | Agent | 3961 N TAMARACK DR, BOISE, ID 83703 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Gayle Matsumuro | Member | 3961 N TAMARACK DR, BOISE, ID 83703 | 2022-03-23 |
| Name | Role | Address | Appointed On | Resigned On |
|---|---|---|---|---|
| Gayle Matsumuro | Manager | 3961 N TAMARACK DR, BOISE, ID 83703 | 2021-03-13 | 2022-03-23 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Annual Report | 0005463566 | 2023-11-05 |
| Annual Report Amendment | 0005335800 | 2023-07-31 |
| Annual Report | 0005007685 | 2022-12-03 |
| Application for Reinstatement | 0004670360 | 2022-03-23 |
| Dissolution/Revocation - Administrative | 0004668648 | 2022-03-23 |
| Application for Reinstatement | 0004208877 | 2021-03-13 |
| Dissolution/Revocation - Administrative | 0004208206 | 2021-03-13 |
| Initial Filing | 0003712971 | 2019-12-19 |
Date of last update: 01 Jan 2025
Sources: Idaho Secretary of State
