MEDICARE: DYNAMIC LIVING COUNSELING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1316718406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC LIVING COUNSELING INC

Provider Business Mailing Address
First Line	:	1501 E OSBORN RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5350
Country	:	US
Telephone Number	:	602-277-2112
Fax Number	:	480-383-6972

Provider Business Practice Location Address
First Line	:	1555 S GILBERT RD STE 103
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	602-277-2112
Fax Number	:	480-383-6972

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MARK A THIELE
Credential	:
Telephone Number	:	602-277-2112

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	02/03/2026

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