Healthcare Provider Details

I. General information

NPI: 1316718406
Provider Name (Legal Business Name): DYNAMIC LIVING COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S GILBERT RD STE 103
MESA AZ
85204-6000
US

IV. Provider business mailing address

1501 E OSBORN RD STE 103
PHOENIX AZ
85014-5350
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-2112
  • Fax: 480-383-6972
Mailing address:
  • Phone: 602-277-2112
  • Fax: 480-383-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK A THIELE
Title or Position: CEO/OWNER
Credential:
Phone: 602-277-2112