Provider Demographics
NPI:1710111349
Name:DIEFFENBACH, THAIR R (LMHC, PHD)
Entity Type:Individual
Prefix:
First Name:THAIR
Middle Name:R
Last Name:DIEFFENBACH
Suffix:
Gender:F
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5054
Mailing Address - Country:US
Mailing Address - Phone:352-683-1842
Mailing Address - Fax:352-683-0247
Practice Address - Street 1:13215 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5054
Practice Address - Country:US
Practice Address - Phone:352-683-1842
Practice Address - Fax:352-683-0247
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002734101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4806OtherBCBS