Healthcare Provider Details

I. General information

NPI: 1205943180
Provider Name (Legal Business Name): DARREN JAMES GILLESPIE CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date: 01/06/2020
Reactivation Date: 01/28/2020

III. Provider practice location address

3714 E CAMPUS DR STE 101
EAGLE MOUNTAIN UT
84005-5451
US

IV. Provider business mailing address

3714 E CAMPUS DR STE 101
EAGLE MOUNTAIN UT
84005-5451
US

V. Phone/Fax

Practice location:
  • Phone: 801-789-7780
  • Fax:
Mailing address:
  • Phone: 801-789-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5714449-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: