Provider Demographics
NPI:1629701388
Name:TERLECKYJ, STEFAN (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:TERLECKYJ
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 STEPHENSON HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1132
Mailing Address - Country:US
Mailing Address - Phone:248-585-3239
Mailing Address - Fax:248-616-9759
Practice Address - Street 1:550 STEPHENSON HWY STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1132
Practice Address - Country:US
Practice Address - Phone:248-585-3239
Practice Address - Fax:248-616-9759
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511151411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical