| Name: | MedOp Behavioral Health Associates of Rhode Island, P.C. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 16 Oct 2006 (19 years ago) |
| Date of Dissolution: | 28 Feb 2023 (2 years ago) |
| Date of Status Change: | 28 Feb 2023 (2 years ago) |
| Identification Number: | 000159067 |
| Principal Address: | 1480 BOSTON POST ROAD, OLD SAYBROOK, CT, 06475, USA |
| Purpose: | BEHAVIORAL HEALTH SERVICES |
| Fictitious names: |
LifeStance Health (trading name, 2021-06-29 - 2021-11-08) |
NAICS
621330 Offices of Mental Health Practitioners (except Physicians)This industry comprises establishments of independent mental health practitioners (except physicians) primarily engaged in (1) the diagnosis and treatment of mental, emotional, and behavioral disorders and/or (2) the diagnosis and treatment of individual or group social dysfunction brought about by such causes as mental illness, alcohol and substance abuse, physical and emotional trauma, or stress. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013129220 | 2007-05-03 | 2016-08-30 | 55 HATCHETTS HILL RD, OLD LYME, CT, 063711534, US | 222 JEFFERSON BLVD, SUITE 200, WARWICK, RI, 028883847, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 800-370-3651 |
| Fax | 8605100020 |
Authorized person
| Name | DONNA DOOLEY |
| Role | CFO |
| Phone | 8003703651 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 163WP0809X - Adult Psychiatric/Mental Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 164W00000X - Licensed Practical Nurse |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0600X - Clinical Neurophysiology Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 364SG0600X - Gerontology Clinical Nurse Specialist |
| Is Primary | No |
| Taxonomy Code | 364SP0808X - Psychiatric/Mental Health Clinical Nurse Specialist |
| Is Primary | No |
| Taxonomy Code | 364SP0809X - Adult Psychiatric/Mental Health Clinical Nurse Specialist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | MB68062 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | 222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA |
| Name | Role | Address |
|---|---|---|
| ANISHA PATEL-DUNN | PRESIDENT | 10655 NE 4TH ST, STE 901 BELLEVUE, WA 98004 USA |
| Name | Role | Address |
|---|---|---|
| RYAN PARDO | SECRETARY | 10655 NE 4TH ST, STE 901 BELLEVUE, WA 98004 USA |
| Number | Name | File Date |
|---|---|---|
| 202329556750 | Articles of Dissolution | 2023-02-28 |
| 202221201730 | Statement of Change of Registered/Resident Agent | 2022-07-13 |
| 202211525730 | Annual Report | 2022-02-24 |
| 202104798900 | Statement of Abandonment of Use of Fictitious Business Name | 2021-11-07 |
| 202198809010 | Fictitious Business Name Statement | 2021-06-29 |
| 202198568160 | Statement of Change of Registered/Resident Agent | 2021-06-23 |
| 202191408580 | Annual Report | 2021-02-16 |
| 202033971720 | Annual Report | 2020-02-08 |
| 201987980510 | Annual Report | 2019-03-01 |
| 201859449060 | Annual Report | 2018-03-01 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
