MEDICARE: MR. DANIEL GREGORY OLADOKUN-DYBOWSKI LMSW

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	101Y00000X	Counselor	LMSW-20399	AZ
2	101YM0800X	Mental Health Counselor	LMSW-20399	AZ
3	171400000X	Health & Wellness Coach	LMSW-20399	AZ
4	175F00000X	Naturopath	LMSW-20399	AZ
5	175L00000X	Homeopath	LMSW-20399	AZ
6	104100000X	Social Worker	LMSW-20399	AZ

General Provider Information

NPI Number	:	1417661158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL GREGORY OLADOKUN-DYBOWSKI LMSW

Provider Business Mailing Address
First Line	:	640 E PALO VERDE ST
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-1628
Country	:	US
Telephone Number	:	520-431-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E 1ST ST
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5201
Country	:	US
Telephone Number	:	520-421-1120
Fax Number	:	520-421-2877

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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