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Psychological Preventative Health PLLC

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Company Details

Name: Psychological Preventative Health PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 06 Aug 2018 (7 years ago)
Financial Date End: 31 Aug 2024
Date dissolved: 15 Nov 2024
Entity Number: 621613
Place of Formation: IDAHO
File Number: 621613
ZIP code: 83404
County: Bonneville County
Principal Address: MELANIE RICHARDSON 157 2184 CHANNING WAY IDAHO FALLS, ID 83404
Mailing Address: MELANIE RICHARDSON 2184 CHANNING WAY # 157 IDAHO FALLS, ID 83404-8034

Agent

Name Role Address
Melanie Richardson Agent 2184 CHANNING WAY, 157, IDAHO FALLS, ID 83404

Member

Name Role Address Appointed On Resigned On
Michael J Richardson Member 2184 CHANNING WAY, IDAHO FALLS, ID 83404 2020-07-07 2020-10-06
Michael Richardson Member 2184 CHANNING WAY # 157, IDAHO FALLS, ID 83404-8034 2020-10-06 No data

National Provider Identifier

NPI Number:
1649808767
Certification Date:
2022-02-08

Authorized Person:

Name:
MELANIE RICHARSON
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
8888879784

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005982027 2024-11-15
Annual Report 0005324322 2023-07-17
Annual Report 0004829651 2022-07-22
Annual Report 0004406009 2021-09-05
Annual Report 0004026275 2020-10-06

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Date of last update: 12 Apr 2025

Sources: Idaho Secretary of State