MEDICARE: 4S WELLNESS SERVICES

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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1487324083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4S WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	305 WAYNE ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1327
Country	:	US
Telephone Number	:	708-466-8853
Fax Number	:	708-367-9980

Provider Business Practice Location Address
First Line	:	305 WAYNE ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1327
Country	:	US
Telephone Number	:	708-466-8853
Fax Number	:	708-367-9980

Authorized Official
Title or Position	:	CEO
Name	:	MARLAYNA ANTIONETTE WARREN
Credential	:
Telephone Number	:	708-466-8853

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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Directions to “4S WELLNESS SERVICES ” Practice Location

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