Healthcare Provider Details

I. General information

NPI: 1144607169
Provider Name (Legal Business Name): ACCESS COMMUNITY THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHEYENNE AVE SUITE 200
GRAFTON WI
53024-9323
US

IV. Provider business mailing address

1245 CHEYENNE AVE SUITE 200
GRAFTON WI
53024-9323
US

V. Phone/Fax

Practice location:
  • Phone: 262-233-1818
  • Fax: 414-421-8681
Mailing address:
  • Phone: 262-233-1818
  • Fax: 414-421-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHARITY DAWN FANCHER
Title or Position: OPERATIONS ADMIN
Credential:
Phone: 715-842-9500