Provider Demographics
NPI:1598956054
Name:ACCESS MENTAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:ACCESS MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKHTEREV
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:414-276-3455
Mailing Address - Street 1:1442 N FARWELL AVE
Mailing Address - Street 2:#104
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2913
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:#104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2913
Practice Address - Country:US
Practice Address - Phone:414-276-3455
Practice Address - Fax:414-276-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42208200Medicaid
44220Medicare PIN