MEDICARE: ACCESS MENTAL HEALTH CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598956054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MENTAL HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	1442 N FARWELL AVE
Second Line	:	#104
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2913
Country	:	US
Telephone Number	:	414-276-3455
Fax Number	:	414-276-3460

Provider Business Practice Location Address
First Line	:	1442 N FARWELL AVE
Second Line	:	#104
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2913
Country	:	US
Telephone Number	:	414-276-3455
Fax Number	:	414-276-3460

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. VICTOR LIKHTEREV
Credential	:	MS LPC
Telephone Number	:	414-276-3455

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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Directions to “ACCESS MENTAL HEALTH CLINIC LLC ” Practice Location

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