Healthcare Provider Details

I. General information

NPI: 1902575749
Provider Name (Legal Business Name): OLENA TETYUK LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 LIVERNOIS ST STE 202
FERNDALE MI
48220-2676
US

IV. Provider business mailing address

359 LIVERNOIS ST STE 202
FERNDALE MI
48220-2676
US

V. Phone/Fax

Practice location:
  • Phone: 248-256-5417
  • Fax:
Mailing address:
  • Phone: 248-256-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007787
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: