MEDICARE: BEHAVIORAL HEALTH CLINIC, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	103TC1900X	Counseling Psychologist
3	101YM0800X	Mental Health Counselor
4	103T00000X	Psychologist
5	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
6	104100000X	Social Worker
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	106H00000X	Marriage & Family Therapist
9	101YA0400X	Addiction (Substance Use Disorder) Counselor
10	103TS0200X	School Psychologist
11	1041C0700X	Clinical Social Worker
12	101YP2500X	Professional Counselor
13	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1902698533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH CLINIC, LLC

Provider Business Mailing Address
First Line	:	630 S 36TH AVE
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54401-3930
Country	:	US
Telephone Number	:	715-842-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 CHEYENNE AVE STE 200
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9323
Country	:	US
Telephone Number	:	715-842-9500
Fax Number	:	715-848-0425

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

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	02/04/2026

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