Healthcare Provider Details

I. General information

NPI: 1881371979
Provider Name (Legal Business Name): 4GCONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 W 100TH ST
CHICAGO IL
60655-1657
US

IV. Provider business mailing address

2608 W 100TH ST
CHICAGO IL
60655-1657
US

V. Phone/Fax

Practice location:
  • Phone: 773-612-4784
  • Fax:
Mailing address:
  • Phone: 773-445-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONALD FORGUE
Title or Position: OWNER
Credential: NCC, LPC, QMHP
Phone: 708-398-0608