Provider Demographics
NPI:1326572397
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:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ADAM
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:026-277-2112
Mailing Address - Fax:602-294-6636
Practice Address - Street 1:1501 E OSBORN RD
Practice Address - Street 2:STE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-277-2112
Practice Address - Fax:602-294-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG8115251S00000X
AZCSLG8127251S00000X
AZCSLG8117251S00000X
AZCSLG8126251S00000X
AZCSLG8116251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health