Provider Demographics
NPI:1912936386
Name:DARR, JOHN WESLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WESLEY
Last Name:DARR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PAPILLON DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1054
Mailing Address - Country:US
Mailing Address - Phone:618-234-5976
Mailing Address - Fax:618-310-1309
Practice Address - Street 1:6 EMERALD TER
Practice Address - Street 2:SUITE 4
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-234-5976
Practice Address - Fax:618-310-1309
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7144OtherBCBS-MO
IL8232082OtherBCBS- IL
MO7144OtherBCBS-MO