Organization
SPECIALIZED FORENSIC UNIT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TETYANA KOSTYSHYNA PSYD, LCPC, LSOE/TP (PSYCHOLOGIST, MANAGER)
(312) 818-9300
Entity
Organization
Contact information
Practice address
555 S RANDALL RD STE 204, ST CHARLES, IL 60174-5918
(312) 818-9300
Mailing address
555 S RANDALL RD STE 204, ST CHARLES, IL 60174-5918
(312) 818-9300
(888) 488-2604
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/06/2017
Last updated
11/04/2024
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