MEDICARE: VICTOR R LIKHTEREV MS LPC

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	101YP2500X	Professional Counselor	2463125	WI

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	:	1578787487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR R LIKHTEREV MS LPC

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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