Healthcare Provider Details

I. General information

NPI: 1548875958
Provider Name (Legal Business Name): BROOKE ALISON DYBKA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ALISON MILLS

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MESQUITE AVE STE 6
LAKE HAVASU CITY AZ
86403-5772
US

IV. Provider business mailing address

1930 MESQUITE AVE STE 6
LAKE HAVASU CITY AZ
86403-5772
US

V. Phone/Fax

Practice location:
  • Phone: 928-599-7794
  • Fax: 928-543-7175
Mailing address:
  • Phone: 928-599-7794
  • Fax: 928-543-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-8496
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: