Healthcare Provider Details

I. General information

NPI: 1831842384
Provider Name (Legal Business Name): DYBKA BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
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

9169 W STATE ST
GARDEN CITY ID
83714-1733
US

V. Phone/Fax

Practice location:
  • Phone: 619-961-7088
  • Fax: 208-820-1495
Mailing address:
  • Phone: 619-961-7088
  • Fax: 928-543-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: BROOKE ALISON DYBKA
Title or Position: OWNER
Credential: LMFT
Phone: 928-599-7794