Healthcare Provider Details

I. General information

NPI: 1518580745
Provider Name (Legal Business Name): DARSHAYA MARIE GALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 PERSON ST
LARAMIE WY
82070-5454
US

IV. Provider business mailing address

PO BOX 2131
LARAMIE WY
82073-2131
US

V. Phone/Fax

Practice location:
  • Phone: 307-228-1030
  • Fax:
Mailing address:
  • Phone: 949-607-6658
  • Fax: 307-733-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-768
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: