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Mindful Moments Psychiatry LLC

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Company Details

Name: Mindful Moments Psychiatry LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 07 May 2024 (a year ago)
Financial Date End: 31 May 2025
Date dissolved: 14 Apr 2025
Entity Number: 5728426
Place of Formation: IDAHO
File Number: 935628
ZIP code: 83686
County: Canyon County
Principal Address: 270 WEST GEORGIA AVENUE NAMPA, ID 83686
Mailing Address: 708 N HORTON ST NAMPA, ID 83651-1936

Agent

Name Role Address
REGISTERED AGENTS INC Agent 784 S CLEARWATER LOOP STE R, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1942048368
Certification Date:
2024-07-18

Authorized Person:

Name:
KERRIE PETECH
Role:
OWNER/PRESCRIBER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0006205984 2025-04-14
Initial Filing 0005728426 2024-05-07

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State