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General NPI Number Information
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NPI Number | 1487324083
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Entity Type | Organization
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Legal Business Name | 4S WELLNESS SERVICES
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 305 WAYNE ST
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City | PARK FOREST
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State | IL
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Zip | 60466-1327
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Country | US
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Telephone | 708-466-8853
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Fax | 708-367-9980
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Provider Business Mailing Address
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Address Line | 305 WAYNE ST
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City | PARK FOREST
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State | IL
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Zip | 60466-1327
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Country | US
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Telephone | 708-466-8853
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Fax | 708-367-9980
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Authorized Official
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Title or Position | CEO
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Name | MARLAYNA ANTIONETTE WARREN
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Credential |
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Telephone | 708-466-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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