Provider Demographics
NPI:1356843049
Name:DARREN J GILLESPIE LCSW, LLC
Entity Type:Organization
Organization Name:DARREN J GILLESPIE LCSW, LLC
Other - Org Name:EAGLE MOUNTAIN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-789-7780
Mailing Address - Street 1:3714 E CAMPUS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5451
Mailing Address - Country:US
Mailing Address - Phone:801-789-7780
Mailing Address - Fax:801-789-7700
Practice Address - Street 1:3714 E CAMPUS DR STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5451
Practice Address - Country:US
Practice Address - Phone:801-789-7780
Practice Address - Fax:801-789-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5714449-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty