Provider Demographics
NPI:1851400444
Name:GALLAHER, DARVIS QUINN (PH D)
Entity Type:Individual
Prefix:
First Name:DARVIS
Middle Name:QUINN
Last Name:GALLAHER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AFTON DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8635
Mailing Address - Country:US
Mailing Address - Phone:731-658-6113
Mailing Address - Fax:731-658-6165
Practice Address - Street 1:10710 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3587
Practice Address - Country:US
Practice Address - Phone:731-658-6113
Practice Address - Fax:731-658-6165
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP 1843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3066307OtherBCBS PROVIDER NUMBER
TN3066307OtherBCBS PROVIDER NUMBER