Provider Demographics
NPI:1891113940
Name:TAYLOR, GILLIAN DECLARK (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:DECLARK
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:MISS
Other - First Name:GILLIAN
Other - Middle Name:DRAPER
Other - Last Name:DECLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2653 W OGDEN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1647
Mailing Address - Country:US
Mailing Address - Phone:770-257-5312
Mailing Address - Fax:773-257-5330
Practice Address - Street 1:2653 W OGDEN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:770-257-5312
Practice Address - Fax:773-257-5330
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional