Provider Demographics
NPI:1063942449
Name:DARBY, DONNA TELIEN (M ED)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:TELIEN
Last Name:DARBY
Suffix:
Gender:
Credentials:M ED
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:TELIEN
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1269 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-3740
Mailing Address - Country:US
Mailing Address - Phone:409-988-2932
Mailing Address - Fax:
Practice Address - Street 1:1269 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-3740
Practice Address - Country:US
Practice Address - Phone:409-988-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1942672910Medicaid
TX377047102Medicaid