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NPI Code Detail

MEDICARE: DYNAMIC LIVING COUNSELING INC

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
1251S00000XCommunity/Behavioral Health AgencyCSLG8127AZ
2251S00000XCommunity/Behavioral Health AgencyCSLG8116AZ
3251S00000XCommunity/Behavioral Health AgencyCSLG8117AZ
4251S00000XCommunity/Behavioral Health AgencyCSLG8126AZ
5251S00000XCommunity/Behavioral Health Agency
6251S00000XCommunity/Behavioral Health AgencyCSLG8115AZ

General Provider Information

NPI Number : 1326572397
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 : 602-294-6636
Provider Business Practice Location Address
First Line : 1501 E OSBORN RD
Second Line : STE 103
City : PHOENIX
State : AZ
Zip : 85014
Country : US
Telephone Number : 602-277-2112
Fax Number : 602-294-6636
Authorized Official
Title or Position : CEO/OWNER
Name : MR. MARK ADAM THIELE
Credential :
Telephone Number : 602-277-2112
Provider Enumeration Date : 04/17/2017
Last Update Date : 02/03/2026

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Directions to “DYNAMIC LIVING COUNSELING INC ” Practice Location

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