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NICOLE PAN, LICENSED MENTAL HEALTH COUNSELOR, PLLC

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Company Details

Name: NICOLE PAN, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 17 Apr 2014 (11 years ago)
Entity Number: 4563591
ZIP code: 11735
County: Suffolk
Place of Formation: New York
Address: 204 Airport Plaza Blvd #1004, Farmingdale, NY, United States, 11735

Agent

Name Role Address
UNITED STATES CORPORATION AGENTS, INC. Agent 7014 13TH AVENUE, SUITE 202, BROOKLYN, NY, 11228

DOS Process Agent

Name Role Address
NICOLE PAN, LICENSED MENTAL HEALTH COUNSELOR, PLLC DOS Process Agent 204 Airport Plaza Blvd #1004, Farmingdale, NY, United States, 11735

National Provider Identifier

NPI Number:
1861897803

Authorized Person:

Name:
NICOLE PAN
Role:
LICENSED MENTAL HEALTH COUNSELOR
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2020-04-23 2024-04-01 Address 21 GREENE AVENUE, SUITE 205, AMITYVILLE, NY, 11701, USA (Type of address: Service of Process)
2017-07-13 2024-04-01 Address 7014 13TH AVENUE, SUITE 202, BROOKLYN, NY, 11228, USA (Type of address: Registered Agent)
2017-07-13 2020-04-23 Address 7014 13TH AVENUE, SUITE 202, BROOKLYN, NY, 11228, USA (Type of address: Service of Process)
2016-04-27 2017-07-13 Address 21 GREENE AVENUE, SUITE 205, AMITYVILLE, NY, 11701, USA (Type of address: Service of Process)
2014-04-17 2016-04-27 Address 7014 13TH AVENUE,, SUITE 202, BROOKLYN, NY, 11228, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240401040895 2024-04-01 BIENNIAL STATEMENT 2024-04-01
220406001157 2022-04-06 BIENNIAL STATEMENT 2022-04-01
200423060241 2020-04-23 BIENNIAL STATEMENT 2020-04-01
170713000597 2017-07-13 CERTIFICATE OF CHANGE 2017-07-13
160427002033 2016-04-27 BIENNIAL STATEMENT 2016-04-01

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Date of last update: 25 Mar 2025

Sources: New York Secretary of State