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Wisconsin Community Mental Health Program Certification Directory

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Wisconsin Community Mental Health Program Certification Directory DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Quality Assurance Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Community Mental Health Program Certification Directory By County, City, and Provider Name ADAMS FRIENDSHIP ADAMS COUNTY HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 3243 108 E NORTH ST TOM CHARLES Initial Cert: 01/17/2019 FRIENDSHIP, WI 53934 [email protected] Cert Eff: 02/01/2020 County: Adams Phone:(608) 339-4505 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 339-4593 Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2020 01/31/2022 NO BRANCH LOCATIONS ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES 2810 108 E NORTH STREET DIANE OSBORN Initial Cert: 12/10/2008 FRIENDSHIP, WI 53934 [email protected] Cert Eff: 03/01/2021 County: Adams Phone:(608) 339-4505 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 339-4585 CCS Affiliaton:CENTRAL WISCONSIN HEALTH PARTNERSHIP V2 Begin: 01/01/2016 Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2021 02/28/2023 NO BRANCH LOCATIONS ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT 1253 108 E NORTH STREET REBECCA BURRESS Initial Cert: 09/01/1990 FRIENDSHIP, WI 53934 [email protected] Cert Eff: 03/01/2020 County: Adams Phone:(608) 339-4505 Cert Exp: 02/28/2022 Surveyor: Tina Dary Fax: (608) 339-4585 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 BRIDGEWAY ADULT CRISIS STABILIZATION CBRF 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020 Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2020 02/28/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2020 02/28/2022 Non-Certified School Setting(s) Setting Begin/End Dates ADAMS/FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910 03/01/2020 02/28/2022 ADAMS/FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910 03/01/2020 02/28/2022 09/28/2021 Page 1 of 222 Mental Health Program Directory By County, City, and Provider Name FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH & RECOVERY CENTER 3245 302 W LAKE ST PHILIP ROBINSON Initial Cert: 03/14/2019 FRIENDSHIP, WI 53934 [email protected] Cert Eff: 04/01/2020 County: Adams Phone:(608) 474-4355 Cert Exp: 03/31/2022 Surveyor: Tina Dary Fax: () - Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2020 03/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2020 03/31/2022 NO BRANCH LOCATIONS 09/28/2021 Page 2 of 222 Mental Health Program Directory By County, City, and Provider Name ASHLAND ASHLAND ASHLAND COUNTY CCS 3055 514 WEST MAIN STREET VALERIE LEVNO Initial Cert: 01/01/2015 ASHLAND, WI 54806 [email protected] Cert Eff: 01/01/2021 County: Ashland Phone:(715) 682-7171 Cert Exp: 12/31/2022 Surveyor: Rena Andersen Fax: (715) 682-7176 CCS Affiliaton:ASHLAND/BAYFIELD CCS REGION Begin: 05/01/2019 Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2021 12/31/2022 NO BRANCH LOCATIONS ASHLAND COUNTY COMMUNITY SUPPORT PROGRAM 3258 514 MAIN STREET WEST VAL LEVNO Initial Cert: 05/31/2019 ASHLAND, WI 54806 [email protected] Cert Eff: 08/01/2020 County: Ashland Phone:(715) 682-7171 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 682-7176 Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2020 04/30/2022 NO BRANCH LOCATIONS ASHLAND COUNTY HEALTH AND HUMAN SERVICES/NORTHLAND COUNSELING SERVICES 2639 1619 WEST THIRD STREET CAROL LUND Initial Cert: 01/26/2006 ASHLAND, WI 54806 [email protected] Cert Eff: 04/01/2021 County: Ashland Phone:(715) 682-2144 Cert Exp: 03/31/2023 Surveyor: Rena Andersen Fax: (715) 682-2148 Crisis Intervention Services Regional Designation Begin End Lead FAMILY SERVICES SHARED CALL SERVICE 01/01/2020 Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2021 03/31/2023 NO BRANCH LOCATIONS 09/28/2021 Page 3 of 222 Mental Health Program Directory By County, City, and Provider Name BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER 2154 1615 MAPLE LANE THOMAS JENSEN Initial Cert: 10/01/1999 ASHLAND, WI 54806 [email protected] Cert Eff: 10/01/2021 County: Ashland Phone:(715) 685-5400 Cert Exp: 09/30/2023 Surveyor: Rena Andersen Fax: (715) 685-5102 Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2021 09/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2021 09/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2021 09/30/2023 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2021 09/30/2023 Tier Branch Location(s) Branch Begin/End Dates 1 NORTHLAND COLLEGE, 1411 ELLIS AVE, ASHLAND, WI 54806 10/01/2021 09/30/2023 3 ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 54806 10/01/2021 09/30/2023 3 LAKE SUPERIOR PRIMARY SCHOOL, 1101 BINSFIELD ROAD, ASHLAND, WI 54806 10/01/2021 09/30/2023 3 DRUMMOND AREA SCHOOL DISTRICT, 52440 EASTERN AVE, DRUMMOND, WI 54832 10/01/2021 09/30/2023 09/28/2021 Page 4 of 222 Mental Health Program Directory By County, City, and Provider Name BARRON BARRON BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES 2640 335 EAST MONROE AVE ROOM 338 ANN HAY Initial Cert: 01/01/2006 BARRON, WI 54812 [email protected] Cert Eff: 11/01/2019 County: Barron Phone:(715) 537-6134 Cert Exp: 10/31/2021 Surveyor: Rena Andersen Fax: (715) 537-6848 Crisis Intervention Services Regional Designation Begin End Lead NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020 Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 NO BRANCH LOCATIONS BARRON COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES 3230 335 E MONROE AVE ANN HAY Initial Cert: 01/01/2019 BARRON, WI 54812 [email protected] Cert Eff: 01/01/2020 County: Barron Phone:(715) 537-5691 Cert Exp: 12/31/2021 Surveyor: Rena Andersen Fax: (715) 537-6848 CCS Affiliaton:BEST CCS Begin: 01/01/2019 Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2020 12/31/2021 NO BRANCH LOCATIONS CUMBERLAND CUMBERLAND MEMORIAL HOSPITAL INC DBA CUMBERLAND HEALTHCARE 3148 1110 7TH AVENUE KARL ADER Initial Cert: 10/06/2016 CUMBERLAND, WI 54829 [email protected] Cert Eff: 10/01/2021 County: Barron Phone:(715) 822-7530 Cert Exp: 09/30/2023 Surveyor: Rena Andersen Fax: (715) 822-7221 Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 Tier Branch Location(s) Branch Begin/End Dates 1 CUMBERLAND HEALTHCARE - TURTLE LAKE, 632 US HWY 8, TURTLE LAKE, WI 54889 10/01/2021 09/30/2023 Non-Certified School Setting(s) Setting Begin/End Dates CUMBERLAND ELEMENTARY SCHOOL, 1530 2ND AVE, CUMBERLAND, WI 54829 10/01/2021 09/30/2023 RICE LAKE BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2925 935 N MAIN ST, LOWER LEVEL ANN HAY Initial Cert: 11/01/2010 RICE LAKE, WI 54868 [email protected] Cert Eff: 11/01/2019 County: Barron Phone:(715) 537-6134 Cert Exp: 10/30/2021 Surveyor: Rena Andersen Fax: (715) 537-6848 Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/30/2021 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2019 11/29/2019 NO BRANCH LOCATIONS 09/28/2021 Page 5 of 222 Mental Health Program Directory By County, City, and Provider Name MARRIAGE AND FAMILY HEALTH SERVICES, LTD 2707 105 WEST AVENUE VICTOR MICHALEK Initial Cert: 02/01/2007 RICE LAKE, WI 54868 [email protected] Cert Eff: 02/01/2021 County: Barron Phone:(715) 736-5437 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (715) 736-5438 Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 02/01/2021 01/31/2023 NO BRANCH LOCATIONS 09/28/2021 Page 6 of 222 Mental Health Program Directory By County, City, and Provider Name BAYFIELD BAYFIELD RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA CCS 3157 37390 NORTH BRADUM ROAD LORNA GAMBLE Initial Cert: 04/01/2017 BAYFIELD, WI 54814 [email protected] Cert Eff: 01/01/2020 County: Bayfield Phone:(715) 779-3707 Cert Exp: 12/31/2021 Surveyor: Rena Andersen Fax: (715) 779-3782 Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 01/01/2020 12/31/2021 NO BRANCH LOCATIONS RED CLIFF COMMUNITY HEALTH CENTER 3143 36745 AIKEN ROAD NICOLE GURNOE Initial Cert: 05/20/2016 BAYFIELD, WI 54814 [email protected] Cert Eff: 04/01/2021 County: Bayfield Phone:(715) 779-3707 Cert Exp: 03/31/2023 Surveyor: Rena Andersen Fax: (715) 779-3362 Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 03/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 Tier Branch Location(s) Branch Begin/End Dates 2 MISHOMIS WELLNESS CENTER, 37390 N BRADUM ROAD, BAYFIELD, WI 54814 04/01/2021 03/31/2023 Non-Certified School Setting(s) Setting Begin/End Dates BAYFIELD SCHOOL DISTRICT, 300 N 4TH ST, BAYFIELD, WI 54814 04/01/2021 03/31/2023 09/28/2021 Page 7 of 222 Mental Health Program Directory By County, City, and Provider Name IRON RIVER NORTHLAKES COMMUNITY CLINIC AODA SERVICES
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