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: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 MCCULLOCH BLVD PMB 2067
LAKE HAVASU CITY AZ
86403-0961
US

IV. Provider business mailing address

1642 MCCULLOCH BLVD PMB 2067
LAKE HAVASU CITY AZ
86403-0961
US

V. Phone/Fax

Practice location:
  • Phone: 208-497-2197
  • Fax: 208-820-1495
Mailing address:
  • Phone: 208-497-2197
  • Fax: 208-820-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: