Provider Demographics
NPI:1578787487
Name:LIKHTEREV, VICTOR R (MS LPC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:R
Last Name:LIKHTEREV
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 N FARWELL AVE
Mailing Address - Street 2:STE #104 ACCESS MENTAL HEALTH CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-276-3455
Mailing Address - Fax:414-276-3460
Practice Address - Street 1:1442 N FARWELL AVE
Practice Address - Street 2:STE #104 ACCESS MENTAL HEALTH CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202
Practice Address - Country:US
Practice Address - Phone:414-276-3455
Practice Address - Fax:414-276-3460
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2463125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39712700Medicaid