MEDICARE: 4 SISTERS 1 BROTHER ENTERPRISES LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1679315188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4 SISTERS 1 BROTHER ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	38 BARKLEY CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7526
Country	:	US
Telephone Number	:	239-317-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 BARKLEY CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7526
Country	:	US
Telephone Number	:	239-317-5533
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BARBARA JEAN LANZ
Credential	:
Telephone Number	:	239-317-5533

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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