Provider Demographics
NPI:1316718406
Name:DYNAMIC LIVING COUNSELING INC
Entity type:Organization
Organization Name:DYNAMIC LIVING COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-277-2112
Mailing Address - Street 1:1501 E OSBORN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5350
Mailing Address - Country:US
Mailing Address - Phone:602-277-2112
Mailing Address - Fax:480-383-6972
Practice Address - Street 1:1555 S GILBERT RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6000
Practice Address - Country:US
Practice Address - Phone:602-277-2112
Practice Address - Fax:480-383-6972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC LIVING COUNSELING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty