Healthcare Provider Details

I. General information

NPI: 1962322594
Provider Name (Legal Business Name): JAMES DYKSTRA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 E ELGIN ST
CHANDLER AZ
85225-2213
US

IV. Provider business mailing address

1617 E ELGIN ST
CHANDLER AZ
85225-2213
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-2430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-11144
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: