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General NPI Number Information
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NPI Number | 1831842384
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Entity Type | Organization
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Legal Business Name | DYBKA BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1930 MESQUITE AVE STE 6
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5772
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Country | US
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Telephone | 208-497-2197
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Fax | 208-820-1495
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Provider Business Mailing Address
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Address Line | 9169 W STATE ST PMB 379
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City | GARDEN CITY
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State | ID
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Zip | 83714
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Country | US
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Telephone | 928-599-7794
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Fax | 928-543-7175
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Authorized Official
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Title or Position | OWNER
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Name | BROOKE ALISON DYBKA
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Credential | LMFT
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Telephone | 928-599-7794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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