Provider Demographics
NPI:1215940069
Name:DOUGLASS, KAREN YVETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:YVETTE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KAR3N
Other - Middle Name:YVETTE
Other - Last Name:ROLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7712 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2321
Mailing Address - Country:US
Mailing Address - Phone:773-487-0515
Mailing Address - Fax:
Practice Address - Street 1:132 E 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2302
Practice Address - Country:US
Practice Address - Phone:773-487-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042051A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical