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Magnolia Psychiatric, PA

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Company Details

Name: Magnolia Psychiatric, PA
Jurisdiction: MISSISSIPPI
Business Type: Profit Corporation
Status: Dissolved
Effective Date: 13 Oct 2005 (20 years ago)
Business ID: 879781
ZIP code: 39564
County: Jackson
State of Incorporation: MISSISSIPPI
Principal Office Address: 2113 Government Place;Bldg. GOcean Springs, MS 39564

Agent

Name Role Address
Kelley,, Robert H, II Agent 14100 Puerto Drive, Ocean Springs, MS 39564

Incorporator

Name Role Address
Anastasia V. Kelly Incorporator 2124 Government Street, Ocean Springs, MS 39564

Director

Name Role Address
Anastasia Kelley Director 2113 Ste. G, Government Street, Ocean Springs, MS 39564

President

Name Role Address
Anastasia V Kelley, M.d. President 2113 Government Street, Building G, Ocean Springs, MS 39564

National Provider Identifier

NPI Number:
1306031752

Authorized Person:

Name:
MISS TRACEY L MATTINA
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
103T00000X - Psychologist
Is Primary:
Yes

Contacts:

Fax:
2288726300

Filings

Type Status Filed Date Description
Admin Dissolution Filed 2013-10-01 Admin Dissolution
Notice to Dissolve/Revoke Filed 2013-07-01 Notice to Dissolve/Revoke
Annual Report Filed 2012-04-18 Annual Report
Annual Report Filed 2011-09-22 Annual Report
Notice to Dissolve/Revoke Filed 2011-07-25 Notice to Dissolve/Revoke
Annual Report Filed 2010-04-19 Annual Report
Annual Report Filed 2009-01-07 Annual Report
Reinstatement Filed 2008-03-19 Reinstatement
Notice to Dissolve/Revoke Filed 2008-02-15 Notice to Dissolve/Revoke
Annual Report Filed 2007-09-19 Annual Report

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Date of last update: 05 May 2025

Sources: Company Profile on Mississippi Secretary of State Website