MEDICARE: TOTAL ENRICHMENT SERVICES INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1346888781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL ENRICHMENT SERVICES INC.

Provider Business Mailing Address
First Line	:	4941 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3143
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:	888-400-2221

Provider Business Practice Location Address
First Line	:	3335 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2454
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MELANEICE SERCYE
Credential	:	MSW/LSW
Telephone Number	:	708-368-5810

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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