MEDICARE: LINDY SUSAN DIFFENBAUGH LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH7034	FL

General Provider Information

NPI Number	:	1427122506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDY SUSAN DIFFENBAUGH LMHC

Provider Business Mailing Address
First Line	:	9951 ATLANTIC BLVD
Second Line	:	121
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6584
Country	:	US
Telephone Number	:	904-463-0930
Fax Number	:	904-722-3017

Provider Business Practice Location Address
First Line	:	9951 ATLANTIC BLVD
Second Line	:	121
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6584
Country	:	US
Telephone Number	:	904-463-0930
Fax Number	:	904-722-3017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	06/07/2026

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