Healthcare Provider Details

I. General information

NPI: 1245394683
Provider Name (Legal Business Name): DARRYL R. HASLAM PH.D., LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S GLENSTONE AVE STE H
SPRINGFIELD MO
65804-1519
US

IV. Provider business mailing address

1461 W HIGHPOINT CIR
SPRINGFIELD MO
65810-2595
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-9518
  • Fax:
Mailing address:
  • Phone: 417-883-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005-025113
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: