MEDICARE: ACCESS COMMUNITY THERAPIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1144607169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS COMMUNITY THERAPIES LLC

Provider Business Mailing Address
First Line	:	1245 CHEYENNE AVE
Second Line	:	SUITE 200
City	:	GRAFTON
State	:	WI
Zip	:	53024-9323
Country	:	US
Telephone Number	:	262-233-1818
Fax Number	:	414-421-8681

Provider Business Practice Location Address
First Line	:	1245 CHEYENNE AVE
Second Line	:	SUITE 200
City	:	GRAFTON
State	:	WI
Zip	:	53024-9323
Country	:	US
Telephone Number	:	262-233-1818
Fax Number	:	414-421-8681

Authorized Official
Title or Position	:	OPERATIONS ADMIN
Name	:	CHARITY DAWN FANCHER
Credential	:
Telephone Number	:	715-842-9500

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	05/13/2025

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