Provider Demographics
NPI:1427122506
Name:DIFFENBAUGH, LINDY SUSAN (LMHC)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:SUSAN
Last Name:DIFFENBAUGH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 ATLANTIC BLVD
Mailing Address - Street 2:121
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6584
Mailing Address - Country:US
Mailing Address - Phone:904-463-0930
Mailing Address - Fax:904-722-3017
Practice Address - Street 1:9951 ATLANTIC BLVD
Practice Address - Street 2:121
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6584
Practice Address - Country:US
Practice Address - Phone:904-463-0930
Practice Address - Fax:904-722-3017
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health