Healthcare Provider Details

I. General information

NPI: 1093728867
Provider Name (Legal Business Name): GILEAD BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E 79TH ST
CHICAGO IL
60619-2302
US

IV. Provider business mailing address

7712 S WABASH AVE
CHICAGO IL
60619-2321
US

V. Phone/Fax

Practice location:
  • Phone: 773-487-0515
  • Fax:
Mailing address:
  • Phone: 773-485-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042051A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042051A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. KAREN YVETTE DOUGLASS
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 773-487-0515