Business License Application
Business Status
| What would you like to do today: |
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New Application
| Is this a: |
None of the above
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Business Name and Physical Location
| Business Name or Trade Name |
MindEssence Neurofeedback
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| Business Street Address (Physical location of the business cannot be a PO Box) |
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| Mailing Address (Street name and number only) |
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| Business Phone Number |
+19288481165
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| Alternate # (Emergency Phone Number) |
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| Number of Employees |
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| Please read through the list carefully and select the closest description of your business: |
MENTAL/BEHAVIORAL SERVICES
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| Business Description (Please describe in detail the nature of the business) |
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| Start of business date |
2025-02-24
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| Locations where the business or applicant has operated during the last five (5) years |
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| is the business location: |
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| Nature of Ownership |
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Partnership
| 1. Partner/Owner (First Name and Last Name) |
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| Home Street Address (cannot be a PO Box) |
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| Telephone Number |
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| Social Security Number (last four digits only) |
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| 2. Partner/Owner (First Name and Last Name) |
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| Home Street Address (cannot be a PO Box) |
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| Telephone Number |
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| Social Security Number (last four digits only) |
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Federal Tax ID or Social Security Number
| Please provide your Federal ID or Social Security Number |
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Transaction Privilege Tax (Sales Tax)
| Transaction Privilege Tax (TPT) Number |
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