Provider Demographics
NPI:1518580745
Name:GALLARD, DARSHAYA MARIE
Entity Type:Individual
Prefix:
First Name:DARSHAYA
Middle Name:MARIE
Last Name:GALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 SPY GLASS CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-5432
Mailing Address - Country:US
Mailing Address - Phone:949-607-6658
Mailing Address - Fax:307-333-0062
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3036
Practice Address - Country:US
Practice Address - Phone:307-332-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-7681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty