Detail by Officer/Registered Agent Name

Florida Not For Profit Corporation

CHILDREN'S MENTAL HEALTH SERVICES OF SOUTHWEST FLORIDA, INC.

Filing Information
N01000002999 65-1108567 04/26/2001 FL INACTIVE ADMIN DISSOLUTION FOR ANNUAL REPORT 09/19/2003 NONE
Principal Address
1533 HENDRY ST, STE 200
FT MYERS, FL 33901
Mailing Address
1533 HENDRY ST, STE 200
FT MYERS, FL 33901
Registered Agent Name & Address SMOOT, J. TOM III
1533 HENDRY ST, STE 200
FT MYERS, FL 33901
Officer/Director Detail Name & Address

Title PD

HENDERSON, JUSTIN RN MA
P.O. BOX 60846
FT MYERS, FL 33906

Title SD

BROWN, STACEY MA LMHC
33 BARKLEY CIR, STE C
FT MYERS, FL 33907

Title D

RIECHE, OMAR MD
1705 COLONIAL BLVD, STE B-1
FT MYERS, FL 33907

Annual Reports
Report YearFiled Date
2002 02/04/2002