Provider Demographics
NPI:1831842384
Name:DYBKA BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:DYBKA BEHAVIORAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:DYBKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:928-599-7794
Mailing Address - Street 1:9169 W STATE ST
Mailing Address - Street 2:PMB 379
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714
Mailing Address - Country:US
Mailing Address - Phone:928-599-7794
Mailing Address - Fax:928-543-7175
Practice Address - Street 1:1930 MESQUITE AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5772
Practice Address - Country:US
Practice Address - Phone:208-497-2197
Practice Address - Fax:208-820-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health