MEDICARE: MRS. LINDA SUSAN REYNOLDS 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	MH845	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0777	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1659537082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA SUSAN REYNOLDS LMHC

Provider Business Mailing Address
First Line	:	PO BOX 7583
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33911-7583
Country	:	US
Telephone Number	:	239-939-5504
Fax Number	:	239-481-1320

Provider Business Practice Location Address
First Line	:	8359 BEACON BLVD
Second Line	:	#200
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3048
Country	:	US
Telephone Number	:	239-841-2568
Fax Number	:	239-481-1320

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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