Organization
SPECIALIZED FORENSIC UNIT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TETYANA KOSTYSHYNA (CEO)
(800) 488-2604
Entity
Organization
Contact information
Practice address
1005 N WESTERN AVE UNIT 1, CHICAGO, IL 60622-6224
(800) 488-9790
Mailing address
303 N 2ND ST STE 22, ST CHARLES, IL 60174-1804
(312) 818-9300
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
10/12/2023
Last updated
10/12/2023
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