Healthcare Provider Details

I. General information

NPI: 1780590265
Provider Name (Legal Business Name): DALEN BROWN LIVESAY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3038 E CACTUS RD STE 2
PHOENIX AZ
85032-7150
US

IV. Provider business mailing address

414 W KINGS AVE
PHOENIX AZ
85023-3541
US

V. Phone/Fax

Practice location:
  • Phone: 623-499-3218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: