Provider Demographics
NPI:1548875958
Name:DYBKA, BROOKE ALISON (LMFT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALISON
Last Name:DYBKA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ALISON
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9169 W STATE ST STE 379
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1733
Mailing Address - Country:US
Mailing Address - Phone:208-497-2197
Mailing Address - Fax:
Practice Address - Street 1:9169 W STATE ST STE 379
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1733
Practice Address - Country:US
Practice Address - Phone:208-497-2197
Practice Address - Fax:208-820-1495
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-8496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist