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Telemental Health Link, LLC

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Company Details

Name: Telemental Health Link, LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Active-Existing
Date of registration: 28 Aug 2023 (2 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 5361465
Place of Formation: NEW MEXICO
File Number: 893025
ZIP code: 83642
County: Ada County
Principal Address: SUSAN DERIVAS, MANAGER 4055 E. BLUEBERRY ST MERIDIAN, ID 83642-8261
Mailing Address: SUSAN DERIVAS, MANAGER 4055 E BLUEBERRY ST MERIDIAN, ID 83642-8261

Managing Member

Name Role Address Appointed On
Ashley H Fell Managing Member 10170 BERRYWOOD CIR, SHREVEPORT, LA 71106 2024-09-30

Agent

Name Role Address
PHYSICALADDRESS.COM, LLC Agent 9169 W STATE ST, GARDEN CITY, ID 83714

National Provider Identifier

NPI Number:
1437783529
Certification Date:
2024-02-07

Authorized Person:

Name:
SUSAN M DERIVAS
Role:
AO
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2086475008

Filing

Filing Name Filing Number Filing date
Change of Registered Office/Agent/Both (by Entity) 0006115185 2025-02-21
Annual Report 0005915124 2024-09-30
Initial Filing 0005361465 2023-08-28

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Date of last update: 11 Jul 2025

Sources: Idaho Secretary of State