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FRONT BEACH MENTAL HEALTH & WELLNESS, PLLC

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Company Details

Name: FRONT BEACH MENTAL HEALTH & WELLNESS, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 11 Dec 2024 (9 months ago)
Business ID: 1468463
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
ROSE ELLEN CLIFFORD Agent 1101 Robinson St, Ocean Springs, MS 39564

Organizer

Name Role Address
ROSE CLIFFORD Organizer 1101 ROBINSON ST., OCEAN SPRINGS, MS 39564

Member

Name Role Address
ALVIN BAKER Jr Member 1101 Robinson St, Ocean Springs, MS 39564
ROSE ELLEN CLIFFORD Member 1101 Robinson St, Ocean Springs, MS 39564

National Provider Identifier

NPI Number:
1588469761
Certification Date:
2025-02-13

Authorized Person:

Name:
PRISCILLA ROCHA
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0855X - Adolescent and Children Mental Health Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2282200655

Filings

Type Status Filed Date Description
Formation Form Filed 2024-12-11 Formation For FRONT BEACH MENTAL HEALTH & WELLNESS, PLLC

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Date of last update: 24 Jul 2025

Sources: Company Profile on Mississippi Secretary of State Website