Provider Demographics
NPI:1659537082
Name:REYNOLDS, LINDA SUSAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUSAN
Last Name:REYNOLDS
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:PO BOX 7583
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7583
Mailing Address - Country:US
Mailing Address - Phone:239-939-5504
Mailing Address - Fax:239-481-1320
Practice Address - Street 1:8359 BEACON BLVD
Practice Address - Street 2:#200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3048
Practice Address - Country:US
Practice Address - Phone:239-841-2568
Practice Address - Fax:239-481-1320
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0777OtherBCBS