Provider Demographics
NPI:1205943180
Name:GILLESPIE, DARREN JAMES (CSW)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:JAMES
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-02-07
Deactivation Date:2020-01-06
Deactivation Code:
Reactivation Date:2020-01-28
Provider Licenses
StateLicense IDTaxonomies
UT5714449-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical