Healthcare Provider Details

I. General information

NPI: 1992205306
Provider Name (Legal Business Name): DALE JOHN DYBEN DHSC, MCAP, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 54TH ST
WEST PALM BEACH FL
33407-2436
US

IV. Provider business mailing address

5066 STARBLAZE DR
GREENACRES FL
33463-5933
US

V. Phone/Fax

Practice location:
  • Phone: 561-841-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC16433
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP100057
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMHP50016
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2500365
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: