Tetyana Kostyshyna, PSYD, LCPC, LSOE/TP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.009432 Issued in IL

Practice address

555 S Randall Rd Ste 204
St Charles, IL 60174-5918

Phone

(312) 818-9300

Fax

(888) 488-2604

NPI assigned

Aug 8, 2016

Last updated

Nov 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Specialized Forensic Unit PC

  • Adolescent and Children Mental Health Clinic/Center
  • St Charles, IL
  • NPI 1396283768

  Psychologist

  NPD Authorized official
• Specialized Forensic Unit PC

  • Adolescent and Children Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1619758836
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1083168041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S RANDALL RD STE 204",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745918",
            "telephone_number": "312-818-9300",
            "fax_number": "888-488-2604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S RANDALL RD STE 204",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745918",
            "telephone_number": "312-818-9300",
            "fax_number": "888-488-2604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTYSHYNA",
        "first_name": "TETYANA",
        "name_prefix": "Dr.",
        "credential": "PSYD, LCPC, LSOE/TP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3415 - 57",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180009177",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.009432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill M Kombrink
• Joanna Edyta Konopka
• Victoria Katherine Korpitz
• Bethany M Kosek
• Kristen Kostecki, CCC-SLP
• Jayesh M Kothari, M.D.
• Lindsey Kovalik Bianchini, LCSW, LISW-CP
• Laura E Kowalski, LCPC
• Elizabeth Ann Kramer, RN
• Mark W. Kramer, O.D

• Clinical Psychologist in St Charles, IL
• Providers in St Charles, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.