MEDICARE: OLENA TETYUK LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6361007787	MI
2	103T00000X	Psychologist	6361007787	MI

General Provider Information

NPI Number	:	1902575749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLENA TETYUK LLP

Provider Business Mailing Address
First Line	:	359 LIVERNOIS ST STE 202
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2676
Country	:	US
Telephone Number	:	248-256-5417
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 LIVERNOIS ST STE 202
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2676
Country	:	US
Telephone Number	:	248-256-5417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	04/23/2026

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Directions to “ OLENA TETYUK LLP” Practice Location

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