Provider Demographics
NPI:1093155418
Name:DARBY, DENARIUS
Entity Type:Individual
Prefix:
First Name:DENARIUS
Middle Name:
Last Name:DARBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 S SHIELDS BLVD
Mailing Address - Street 2:APT 2J
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9516 S SHIELDS BLVD
Practice Address - Street 2:APT 2J
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3100
Practice Address - Country:US
Practice Address - Phone:337-298-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health