4S Wellness Services

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

Legal business name

4S WELLNESS SERVICES

Practice address

305 Wayne St
Park Forest, IL 60466-1327

Phone

(708) 466-8853

Fax

(708) 367-9980

NPI assigned

Sep 15, 2021

Last updated

Sep 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marlayna Antionette Warren

Title

Ceo

Phone

(708) 466-8853

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1487324083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 WAYNE ST",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661327",
            "telephone_number": "708-466-8853",
            "fax_number": "708-367-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 WAYNE ST",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661327",
            "telephone_number": "708-466-8853",
            "fax_number": "708-367-9980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 Wayne St",
            "address_purpose": "LOCATION",
            "city": "Park Forest",
            "state": "IL",
            "postal_code": "604661327",
            "country_code": "US",
            "telephone_number": "708-466-8853",
            "fax_number": "708-367-9980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "4S WELLNESS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "MARLAYNA",
        "authorized_official_middle_name": "ANTIONETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-466-8853"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@4swellnessservices.com",
            "affiliation": "N",
            "endpointDescription": "info@4swellnessservices.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "305 Wayne St",
            "city": "Park Forest",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604661327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.