Provider Demographics
NPI:1831842384
Name:DYBKA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:DYBKA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-961-7088
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:208-820-1495
Practice Address - Street 1:2033 MESA CANYON DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6518
Practice Address - Country:US
Practice Address - Phone:208-497-2197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)