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
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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 1064
7665 US HWY 2 JASON AKL Initial Cert: 09/01/1984 IRON RIVER, WI 54847 [email protected] Cert Eff: 01/01/2021 County: Bayfield Phone:(715) 372-5001 Cert Exp: 08/31/2022 Surveyor: Rena Andersen Fax: (715) 372-5067
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 NORTHLAKES COMM CLINIC-DOWNTOWN, 300 MAIN STREET WEST, ASHLAND, WI 54806 01/01/2021 08/31/2022 2 NORTHLAKES COMMUNITY CLINIC - BIRCHWOOD, 108 S MAIN ST / PO BOX 98, BIRCHWOOD, WI 01/01/2021 08/31/2022 54817 2 NORTHLAKES CLINIC-HAYWARD RIVERS EDGE, 15954 RIVERS EDGE DR, #121, HAYWARD, WI 54843 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-HURLEY, 115 5TH AVENUE NORTH, HURLEY, WI 54534 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-LAKEWOOD, 15397 HIGHWAY 32, LAKEWOOD, WI 54138 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-MINONG, 600 SHELL CREEK ROAD, MINONG, WI 54859 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-PARK FALLS, 500 BIRCH STREET, PARK FALLS, WI 54552 01/08/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-TURTLE LAKE, 730 SWEDE AVE, TURTLE LAKE, WI 54889 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-WASHBURN, 320 SUPERIOR AVENUE, WASHBURN, WI 54891 01/01/2021 08/31/2022 2 NORTHLAKES COMM CLINIC-WHITE LAKE, 524 BISSEL ST, WHITE LAKE, WI 54491 01/01/2021 08/31/2022
3 ALMENA ELEMENTARY SCHOOL, 230 LULU AVE, ALMENA, WI 54805 01/01/2021 08/31/2022 3 ANTIGO HIGH SCHOOL, 1900 10TH AVENUE, ANTIGO, WI 54409 01/01/2021 08/31/2022 3 ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI 54806 01/01/2021 08/31/2022 3 ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 54806 01/01/2021 08/31/2022 3 LAKE SUPERIOR PRIMARY & ELEMENTARY, 1101 BINSFIELD ROAD, ASHLAND, WI 54806 01/01/2021 08/31/2022 3 BARRON HIGH SCHOOL, 1050 E WODDLAND AVE, BARRON, WI 54812 01/01/2021 08/31/2022 3 RIVERVIEW MIDDLE SCHOOL, 135 W RIVER AVE, BARRON, WI 54812 01/01/2021 08/31/2022 3 WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVE, BARRON, WI 54812 01/01/2021 08/31/2022 3 BIRCHWOOD ELEMENTARY SCHOOL, 300 S WILSON STREET, BIRCHWOOD, WI 54817 01/01/2021 08/31/2022 3 CAMERON HIGH SCHOOL, 750 S 1ST STREET, CAMERON, WI 54822 01/01/2021 08/31/2022 3 CAMERON MIDDLE SCHOOL, 750 S 1ST STREET, CAMERON, WI 54822 01/01/2021 08/31/2022 3 CLAYTON SCHOOL, 236 POLK AVENUE WEST, CLAYTON, WI 54004 01/01/2021 08/31/2022 3 CLEAR LAKE ELEMENTARY SCHOOL, 135 8TH AVENUE, CLEAR LAKE, WI 54005 01/01/2021 08/31/2022 3 CLEAR LAKE JR/SR HIGH SCHOOL, 1101 THIRD ST SW, CLEAR LAKE, WI 54005 01/01/2021 08/31/2022 3 CRANDON SCHOOLS PK-12, 9750 US HWY 8, CRANDON, WI 54520 01/01/2021 08/31/2022 3 DRUMMOND SCHOOLS PK-12, 52440 EASTERN AVENUE, DRUMMOND, WI 54832 01/01/2021 08/31/2022 3 GILLETT SCHOOLS K-12, 208 WEST MAIN STREET, GILLETT, WI 54124 01/01/2021 08/31/2022 3 HAYWARD ELEMENTARY/INTERMEDIATE, 15930 WEST 5TH ST, HAYWARD, WI 54843 01/01/2021 08/31/2022 3 HAYWARD HIGH SCHOOL, 10320 NORTH GREENWOOD LANE, HAYWARD, WI 54843 01/07/2021 08/31/2022 3 HAYWARD MIDDLE SCHOOL, 10408 N GREENWOOD LANE, HAYWARD, WI 54843 01/01/2021 08/31/2022 3 HURLEY SCHOOLS K-12, 5503 W RANGEVIEW DR, HURLEY, WI 54534 01/01/2021 08/31/2022 3 NORTHWOOD SCHOOLS K-12, N14463 HWY 53, MINONG, WI 54859 01/01/2021 08/31/2022 3 NORTHWESTERN ELEMENTARY, 10465 E US HWY 2, POPLAR, WI 54864 01/01/2021 08/31/2022 3 NORTHWESTERN MIDDLE, 10523 E US HWY 2, POPLAR, WI 54864 01/01/2021 08/31/2022 3 PRAIRIE FARM SCHOOL, 630 RIVER AVE S, PRAIRIE FARM, WI 54762 01/01/2021 08/31/2022 3 RICE LAKE HIGH SCHOOL, 30 SOUTH WISCONSIN, RICE LAKE, WI 54868 01/01/2021 08/31/2022 3 RICE LAKE MIDDLE SCHOOL, 204 CAMERON ROAD, RICE LAKE, WI 54868 01/01/2021 08/31/2022 3 RIDGELAND ELEMENTARY SCHOOL, 315 MAIN ST, RIDGELAND, WI 54763 01/01/2021 08/31/2022 3 SURING PUBLIC SCHOOLS K-12, 411 E ALGOMA ST, SURING, WI 54174 01/01/2021 08/31/2022 3 TURTLE LAKE SCHOOL DISTRICT, 205 OAK STREET NORTH, TURTLE LAKE, WI 54889 01/01/2021 08/31/2022 09/28/2021 Page 8 of 222 Mental Health Program Directory By County, City, and Provider Name
3 WABENO ELEMENTARY SCHOOL, 4346 MILL LN, WABENO, WI 54566 01/01/2021 08/31/2022 3 WABENO MIDDLE/HIGH SCHOOL, 4325 N BRANCH STREET, WABENO, WI 54566 01/01/2021 08/31/2022 3 WASHBURN ELEMENTARY/ELC, 411 W 8TH STREET, WASHBURN, WI 54891 01/01/2021 08/31/2022 3 WASHBURN MIDDLE/HIGH SCHOOL, 305 4TH AVENUE WEST, WASHBURN, WI 54891 01/01/2021 08/31/2022 3 WHITE LAKE K-12, 405 BISSELL ST, WHITE LAKE, WI 54491 01/01/2021 08/31/2022 3 WINTER SCHOOLS K-12, 6585 WEST GROVE ST, WINTER, WI 54896 01/01/2021 08/31/2022
WASHBURN BAYFIELD COUNTY CCS 3054
117 EAST FIFTH STREET VALERIE LEVNO Initial Cert: 01/01/2015 WASHBURN, WI 54891 [email protected] Cert Eff: 01/01/2021 County: Bayfield Phone:(715) 373-6144 Cert Exp: 12/31/2022 Surveyor: Rena Andersen Fax: (715) 373-6130
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
NORTHLAND COMMUNITY SERVICES BAYFIELD 3253
21 W OMAHA ST CAROL LUND Initial Cert: 03/18/2019 WASHBURN, WI 54891 [email protected] Cert Eff: 03/01/2020 County: Bayfield Phone:(715) 373-0160 Cert Exp: 02/28/2022 Surveyor: Rena Andersen Fax: (715) 373-0162
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
NORTHLAND COUNSELING SERVICES 2361
21 W OMAHA STREET CAROL LUND Initial Cert: 07/01/2001 WASHBURN, WI 54891 [email protected] Cert Eff: 10/01/2020 County: Bayfield Phone:(715) 373-0160 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 373-0162
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NORTHLAND COUNSELING SERVICES - ASHLAND, 1613 WEST THIRD STREET, ASHLAND, WI 54806 10/01/2020 06/30/2022 1 NORTHLAND COUNSELING SERVICES, BEAL AVE, 10752 BEAL AVE, HAYWARD, WI 54843 10/01/2020 06/30/2022
2 NORTHLAND COUNSELING SERVICES, 1619 WEST 3RD ST, ASHLAND, WI 54806 10/01/2020 06/30/2022 2 NORTHLAND COUNSELING SERVICES - EAGLE RIVER, 611 EAST WALL ST, EAGLE RIVER, WI 54521 10/01/2020 06/30/2022
09/28/2021 Page 9 of 222 Mental Health Program Directory By County, City, and Provider Name
BROWN DE PERE AURORA BEHAVIORAL HEALTH CENTER 2736
1881 CHICAGO STREET SARAH DONOVAN Initial Cert: 06/08/2007 DE PERE, WI 54115 [email protected] Cert Eff: 10/01/2020 County: Brown Phone:(920) 403-8061 Cert Exp: 06/30/2022 Surveyor: Renee DeWitt Fax: (920) 403-8209
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA HEALTH CARE - GREEN BAY, 1160 KEPLER DR, GREEN BAY, WI 54311 10/01/2020 06/30/2022 2 AURORA MEDICAL GROUP MARINETTE, 4061 OLD PESHTIGO RD, MARINETTE, WI 54143 10/01/2020 06/30/2022
EMPLOYEE RESOURCE CENTER INC 1301
1511 WEST MAIN AVE SUITE 100 KELLY FABERA Initial Cert: 07/01/1989 DE PERE, WI 54115 [email protected] Cert Eff: 08/01/2020 County: Brown Phone:(920) 403-7600 Cert Exp: 07/31/2022 Surveyor: Renee DeWitt Fax: (920) 403-7360
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 EMPLOYEE RESOURCE CTR-APPLETON, 2565 E CALUMET STREET, STE 6, APPLETON, WI 54915 08/01/2020 07/31/2022
EVOLVE 3326
1710 LAWRENCE DR STE 200 BRENDA VELISSARIS Initial Cert: 06/14/2021 DE PERE, WI 54115 [email protected] Cert Eff: 06/14/2021 County: Brown Phone:(920) 570-6339 Cert Exp: 05/31/2023 Surveyor: Renee DeWitt Fax: (920) 243-1792
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 06/14/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/14/2021 05/31/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 06/14/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 EVOVLE, 3416 ASSOCIATION DR, APPLETON, WI 54914 06/14/2021 05/31/2023
LIVING HOPE CHRISTIAN COUNSELING 2597
2066 LAWRENCE DRIVE KILEY MARTIN Initial Cert: 08/12/2005 DE PERE, WI 54115 [email protected] Cert Eff: 01/01/2021 County: Brown Phone:(920) 338-8699 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (920) 336-3181
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 10 of 222 Mental Health Program Directory By County, City, and Provider Name
SCENIC HOPE COUNSELING LLC 3342
435 N BROADWAY ST KATIE KADONSKY Initial Cert: 07/13/2021 DE PERE, WI 54115 [email protected] Cert Eff: 07/13/2021 County: Brown Phone:(920) 214-5844 Cert Exp: 07/31/2022 Surveyor: Renee DeWitt Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/13/2021 07/31/2022 NO BRANCH LOCATIONS
ST. VINCENT HOSPITAL DBA PREVEA HEALTH 1743
3860 MONROE ROAD LISA TUTSKEY Initial Cert: 12/09/1996 DE PERE, WI 54115 [email protected] Cert Eff: 01/01/2020 County: Brown Phone:(920) 272-1200 Cert Exp: 12/31/2021 Surveyor: Renee DeWitt Fax: (920) 272-1201
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 PREVEA WEST DEPERE HEALTH CENTER, 1686 EISENHOWER RD, DE PERE, WI 54115 01/01/2020 12/31/2021 1 PREVEA FLORENCE HEALTH CENTER, 501 LAKE AVE, FLORENCE, WI 54121 02/14/2020 12/31/2021 1 PREVEA GILLETT HEALTH CENTER, 340 N GREEN BAY AVE, GILLETT, WI 54124 02/14/2020 12/31/2021 1 LODGE KOHLER, 1950 S. RIDGE RD, GREEN BAY, WI 54304 01/07/2021 12/31/2021 1 PREVEA ALLOUEZ HEALTH CENTER, 1821 WEBSTER AVE, GREEN BAY, WI 54301 01/01/2020 12/31/2021 1 PREVEA EAST MASON HEALTH CENTER, 3021 VOYAGER DRIVE, GREEN BAY, WI 54311 01/01/2020 12/31/2021 1 PREVEA SHAWANO AVENUE HEALTH, 1727 SHAWANO AVENUE, GREEN BAY, WI 54303 01/01/2020 12/31/2021 1 UNIVERSITY OF WISCONSIN OF GREEN BAY, 2420 NICOLET DR, GREEN BAY, WI 54311 10/08/2020 12/31/2021 1 PREVEA MENOMINEE HEALTH CENTER, W3275 WOLF RIVER RD, KESHENA, WI 54135 02/20/2020 12/31/2021 1 PREVEA LENA HEALTH CENTERR, 200 S ROSERA ST, LENA, WI 54139 02/14/2020 12/31/2021 1 PREVEA LUXEMBURG HEALTH CENTER, 101 SCHOOL CREEK TRAIL, LUXEMBURG, WI 54217 01/01/2020 12/31/2021 1 PREVEA MOUNTAIN HEALTH CENTER, 14353 HWY 32/64, MOUNTAIN, WI 54149 02/14/2020 12/31/2021 1 PREVEA OCONTO HEALTH CENTER, 620 SMITH STREET, OCONTO, WI 54153 01/01/2020 12/31/2021 1 PREVEA OCONTO FALLS HEALTH CENTER, 853 S MAIN ST, OCONTO FALLS, WI 54154 01/01/2020 12/31/2021 1 PREVEA PULASKI HEALTH CENTER, 940 S AUGUSTINE STREET, PULASKI, WI 54162 01/01/2020 12/31/2021 1 PREVEA SHAWANO HEALTH CENTER, 1300 E GREEN BAY ST, SHAWANO, WI 54166 01/01/2020 12/31/2021 1 PREVEA SURING HEALTH CENTER, 913 E MAIN ST, SURING, WI 54174 02/14/2020 12/31/2021
2 HSHS ST VINCENT HOSPITAL, 835 S VAN BUREN ST, GREEN BAY, WI 54301 01/01/2020 12/31/2021 2 PREVEA HOWARD HEALTH CENTER, 2793 LINEVILLE RD, GREEN BAY, WI 54313 01/01/2020 12/31/2021 2 PREVEA ST MARY'S HEALTH CENTER, 1715 DOUSMAN ST, GREEN BAY, WI 54303 01/01/2020 12/31/2021 2 PREVEA MARINETTE HEALTH CENTER, 1409 CLEVELAND AVE, MARINETTE, WI 54143 01/01/2020 12/31/2021
3 FRANKLIN MIDDLE SCHOOL, 1233 LORE LN, GREEN BAY, WI 54303 01/01/2020 12/31/2021 3 MEADOWBROOK ELEMENTARY, 720 HILLCREST HEIGHTS, GREEN BAY, WI 54313 01/01/2020 12/31/2021 3 ST PAUL'S LUTHERAN SCHOOL, 514 S. CLAY ST, GREEN BAY, WI 54301 02/15/2021 12/31/2021 3 PULASKI HIGH SCHOOL, 1040 S SAINT AUGUSTINE ST, PULASKI, WI 54162 01/01/2020 12/31/2021
09/28/2021 Page 11 of 222 Mental Health Program Directory By County, City, and Provider Name
GREEN BAY BAETEN COUNSELING & CONSULTATION TEAM 3324
2920 S WEBSTER AVE STE B TINA MARIE BAETEN Initial Cert: 03/11/2021 GREEN BAY, WI 54301 [email protected] Cert Eff: 03/11/2021 County: Brown Phone:(920) 632-4471 Cert Exp: 03/31/2023 Surveyor: Renee DeWitt Fax: (920) 632-4315
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/11/2021 03/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/11/2021 03/31/2023 NO BRANCH LOCATIONS
BELLIN PSYCHIATRIC CENTER 1098
301 E ST JOSEPH STREET DIANE KOEPKE Initial Cert: 04/01/1984 GREEN BAY, WI 54301 [email protected] Cert Eff: 07/01/2020 County: Brown Phone:(920) 433-6073 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (920) 431-0333
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2020 03/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2020 03/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 07/01/2020 03/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2020 03/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BELLIN PSYCHIATRIC CTR-ALGOMA, 831 PARKER AVE, ALGOMA, WI 54201 07/01/2020 03/31/2022 1 BELLIN PSYCHIATRIC CTR-BONDUEL, 401 W MILL ST, BONDUEL, WI 54107 07/01/2020 03/31/2022 1 BELLIN PSYCHIATRIC CTR-BRILLION, 964 W RYAN ST, STE B, BRILLION, WI 54110 07/01/2020 03/31/2022 1 BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI 54301 07/01/2020 03/31/2022 1 BELLIN PSYCHIATRIC CTR-GENERATIONS, 704 S WEBSTER AVE, GREEN BAY, WI 54301 07/01/2020 03/31/2022 1 BELLIN PSYCHIATRIC CTR-KEWAUNEE, 575 - 4TH ST, KEWAUNEE, WI 54216 07/01/2020 03/31/2022 1 BELLIN HEALTH WRIGHTSTOWN, 555 QUALITY COURT STE 101, WRIGHTSTOWN, WI 54180 04/15/2021 03/31/2022
2 BELLIN HEALTH RIVERSIDE PSYCHIATRIC GROUP, 1325 ANGELS PATH, DE PERE, WI 54115 07/01/2020 03/31/2022 2 BELLIN PSYCHIATRIC EAST DE PERE, 555 REDBIRD CIRCLE, DE PERE, WI 54115 07/01/2020 03/31/2022 2 BELLIN PSYCHIATRIC WEST DE PERE, 1800 LAWRENCE DR, DE PERE, WI 54115 07/01/2020 03/31/2022 2 BELLIN HEALTH GENERATIONS, 720 S VAN BUREN ST #101, GREEN BAY, WI 54301 07/01/2020 03/31/2022 2 BELLIN PSYCHIATRIC CTR-NEURO TEAM, 725 S WEBSTER, GREEN BAY, WI 54305 07/01/2020 03/31/2022 2 BELLIN LUXEMBURG CLINIC, 140 SCHOOL TRAIL RD, LUXEMBURG, WI 54217 07/01/2020 03/31/2022 2 BELLIN PSYCHIATRIC CTR-OCONTO FALLS, 107 E HIGHLAND DR, OCONTO FALLS, WI 54154 07/01/2020 03/31/2022 2 BELLIN PSYCHIATRIC CTR-STURGEON BAY, 311 N 3RD AVE, STURGEON BAY, WI 54235 07/01/2020 03/31/2022 2 BELLIN HEALTH SURING, 307 MANOR DRIVE, SURING, WI 54174 07/01/2020 03/31/2022
3 ALGOMA ELEMENTARY SCHOOL, 514 FREEMONT STREET, ALGOMA, WI 54201 07/01/2020 03/31/2022 3 ALGOMA MIDDLE AND HIGH SCHOOL, 1715 DIVISION STREET, ALGOMA, WI 54201 07/01/2020 03/31/2022 3 DE PERE HIGH SCHOOL, 1700 CHICAGO ST, DE PERE, WI 54115 08/30/2021 03/31/2022 3 DE PERE MIDDLE SCHOOL, 700 SWAN ROAD, DE PERE, WI 54115 07/01/2020 03/31/2022 3 FOXVIEW INTERMEDIATE SCHOOL, 650 S MICHIGAN, DE PERE, WI 54115 07/01/2020 03/31/2022 3 HEMLOCK CREEK ELEMENTARY SCHOOL, 1900 WILLIAMS GRANT DR, DE PERE, WI 54115 07/01/2020 03/31/2022 3 PHANTOM KNIGHT CHARTER - WEST ACADEMY, 400 REID ST, DE PERE, WI 54115 07/01/2020 03/31/2022 3 WESTWOOD ELEMENTARY SCHOOL, 1155 WESTWOOD, DE PERE, WI 54115 07/01/2020 03/31/2022 3 DANZ ELEMENTARY SCHOOL, 2130 BASTEN STREET, GREEN BAY, WI 54302 07/01/2020 03/31/2022 3 DR. ROSA MINOKA-HILL SCHOOL, 325 N ROOSEVELT, GREEN BAY, WI 54301 07/01/2020 03/31/2022
09/28/2021 Page 12 of 222 Mental Health Program Directory By County, City, and Provider Name
BELLIN PSYCHIATRIC CENTER BEHAVIORAL HEALTH CLINIC ASHWAUBENON 2241
1630 COMMANCHE AVENUE DANIELLE BROCKMAN Initial Cert: 06/30/2000 GREEN BAY, WI 54313 [email protected] Cert Eff: 10/01/2020 County: Brown Phone:(920) 433-6073 Cert Exp: 06/30/2022 Surveyor: Renee DeWitt Fax: (920) 431-0333
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BELLIN PSYCHIATRIC CENTER - TITLETOWN, 1970 S RIDGE RD, GREEN BAY, WI 54304 10/01/2020 06/30/2022 1 BELLIN PSYCHIATRIC CENTER-ONCOLOGY, 1580 COMMANCHE AVENUE, GREEN BAY, WI 54313 10/01/2020 06/30/2022 1 BELLIN PSYCHIATRIC CENTER-UNITED HEALTHCARE, 3100 AMS BLVD, GREEN BAY, WI 54313 10/01/2020 06/30/2022
2 BELLIN PSYCHIATRIC CENTER - HOWARD, 2714 RIVERVIEW DRIVE, GREEN BAY, WI 54313 10/01/2020 06/30/2022 2 BELLIN PSYCHIATRIC CENTER - PULASKI, 723 S. WISCONSIN STREET, PULASKI, WI 54162 10/01/2020 06/30/2022
3 SEYMOUR COMMUNITY HS & MIDDLE SCHOOL, 10 CIRCLE DRIVE, SEYMOUR, WI 54165 10/01/2020 06/30/2022
BELLIN PSYCHIATRIC CENTER BELLEVUE 2442
3263 EATON ROAD DINA BRAUN Initial Cert: 10/10/2002 GREEN BAY, WI 54311 [email protected] Cert Eff: 11/01/2020 County: Brown Phone:(920) 338-2855 Cert Exp: 10/31/2022 Surveyor: Renee DeWitt Fax: (920) 338-9270
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 BELLIN PSYCHIATRIC CENTER-MANITOWOC, 3415 CUSTER ST SUITE D, MANITOWOC, WI 54220 11/01/2020 10/31/2022
3 LUXEMBURG CASCO INTERMEDIATE SCHOOL, 318 N MAIN ST, LUXEMBURG, WI 54217 11/01/2020 10/31/2022 3 LUXEMBURG CASCO MIDDLE SCHOOL, 512 CENTER AVENUE, LUXEMBURG, WI 54217 11/01/2020 10/31/2022 3 LUXEMBURG CASCO PRIMARY SCHOOL, 601 MARCKS LANE, LUXEMBURG, WI 54217 11/01/2020 10/31/2022 3 SEVASTOPOL ELEM, MIDDLE & HIGH SCHOOLS, 4550 HIGHWAY 57, STURGEON BAY, WI 54235 11/01/2020 10/31/2022
BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES 2615
3150 GERSHWIN DRIVE IAN AGAR Initial Cert: 08/25/2005 GREEN BAY, WI 54311 [email protected] Cert Eff: 09/01/2020 County: Brown Phone:(920) 391-6959 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (920) 391-4811
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2020 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 13 of 222 Mental Health Program Directory By County, City, and Provider Name
BROWN COUNTY COMMUNITY TREATMENT CTR 1117
3150 GERSHWIN DRIVE IAN AGAR Initial Cert: 10/01/1975 GREEN BAY, WI 54311 [email protected] Cert Eff: 09/01/2021 County: Brown Phone:(920) 391-6959 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (920) 391-4811 Crisis Intervention Services Regional Designation Begin End Lead BAY HAVEN CRISIS STABILIZATION SERVICE 01/01/2020 BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 FAMILY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2021 08/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2021 08/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI 54305 09/01/2021 08/31/2023
BROWN COUNTY HUMAN SERVICES-CSP BROWN COUNTY COMMUNITY TREATMENT CENTER 2381
3150 GERSHWIN DRIVE IAN AGAR Initial Cert: 06/24/2002 GREEN BAY, WI 54311 [email protected] Cert Eff: 09/01/2021 County: Brown Phone:(920) 391-6959 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (920) 391-4811
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
CATHOLIC CHARITIES, DIOCESE OF GREEN BAY, INC. 1140
1825 RIVERSIDE DRIVE CELIA J GARDNER Initial Cert: 01/01/1988 GREEN BAY, WI 54301 [email protected] Cert Eff: 02/01/2021 County: Brown Phone:(920) 272-8234 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (920) 437-4067
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY, 1712 DUNLAP, STE 5, MARINETTE, WI 02/01/2021 01/31/2023 54143 3 ANNE SULLIVAN ELEMENTARY SCHOOL, 1567 DECKNER AVE, GREEN BAY, WI 54302 02/01/2021 01/31/2023 3 EDISON MIDDLE SCHOOL, 442 ALPINE DR, GREEN BAY, WI 54302 02/01/2021 01/31/2023
09/28/2021 Page 14 of 222 Mental Health Program Directory By County, City, and Provider Name
FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. 1329
300 CROOKS STREET LOIS MISCHLER Initial Cert: 01/12/1996 GREEN BAY, WI 54301 [email protected] Cert Eff: 04/01/2020 County: Brown Phone:(920) 436-6800 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (920) 437-3540
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
Tier Branch Location(s) Branch Begin/End Dates 1 FAMILY SERVICES - SOUTH IRWIN, 626 S IRWIN AVENUE, GREEN BAY, WI 54301 04/01/2020 03/31/2022 1 FAMILY SERVICES RESIDENTIAL, 3430 SPIRIT WAY, GREEN BAY, WI 54304 04/01/2020 03/31/2022 1 FAMILY SERVICES WILLOW TREE CHILD ADVOCACY CENTER, 503 S MONROE STREET, GREEN BAY, 04/01/2020 03/31/2022 WI 54301 3 EAST HIGH SCHOOL, 1415 E WALNUT ST, GREEN BAY, WI 54301 04/01/2020 03/31/2022 3 WRIGHTSTOWN HIGH SCHOOL, 600 HIGH ST, WRIGHTSTOWN, WI 54180 04/01/2020 03/31/2022 3 WRIGHTSTOWN MIDDLE SCHOOL, 400 SCHOOL ST, WRIGHTSTOWN, WI 54180 04/01/2020 03/31/2022
FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. 1332
626 S. IRWIN AVENUE ANDREA M PELTIER Initial Cert: 02/01/1984 GREEN BAY, WI 54301 [email protected] Cert Eff: 04/01/2021 County: Brown Phone:(920) 433-3372 Cert Exp: 03/31/2023 Surveyor: Renee DeWitt Fax: (920) 433-3383
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 15 of 222 Mental Health Program Directory By County, City, and Provider Name
FOUNDATIONS HEALTH AND WHOLENESS 1035
1061 W MASON ST JULIE FELD Initial Cert: 04/01/1981 GREEN BAY, WI 54303 [email protected] Cert Eff: 08/01/2020 County: Brown Phone:(920) 437-8256 Cert Exp: 04/30/2022 Surveyor: Renee DeWitt Fax: (920) 437-1188
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BOYS AND GIRLS CLUB, 311 S ONEIDA ST, GREEN BAY, WI 54303 08/01/2020 04/30/2022 1 FREEDOM HOUSE, 2997 ST ANTHONY DRIVE, GREEN BAY, WI 54311 08/01/2020 04/30/2022 1 NEW COMMUNITY CLINIC - NWTC, 2740 W. MASON ST., GREEN BAY, WI 54307 08/01/2020 04/30/2022 1 NEW COMMUNITY CLINIC, 622 BODART ST, GREEN BAY, WI 54301 08/01/2020 04/30/2022 1 OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI 54303 08/01/2020 04/30/2022
2 AGING & DISABILITY RESOURCE CENTER, 300 S ADAMS ST, GREEN BAY, WI 54303 08/01/2020 04/30/2022 2 BOYS AND GIRLS CLUB, 1451 UNIVERSITY AVE, GREEN BAY, WI 54301 08/01/2020 04/30/2022 2 HOUSE OF HOPE, 1660 CHRISTIANA ST, GREEN BAY, WI 54303 08/01/2020 04/30/2022 2 MICAH CENTER, 700 E WALNUT ST, GREEN BAY, WI 54301 08/01/2020 04/30/2022 2 NEW COMMUNITY SHELTER, 301 MATHER ST, GREEN BAY, WI 54301 08/01/2020 04/30/2022
Non-Certified School Setting(s) Setting Begin/End Dates ALDO LEOPOLD SCHOOL, 622 ELIZA ST, GREEN BAY, WI 54301 08/01/2020 04/30/2022 BAY VIEW MIDDLE SCHOOL, 1217 CARDINAL LANE, GREEN BAY, WI 54313 08/01/2020 04/30/2022 LINEVILLE INTERMEDIATE SCHOOL, 2700 LINEVILLE ROAD, GREEN BAY, WI 54313 08/01/2020 04/30/2022
INNOVATIVE COUNSELING, INC. 2283
1499 SIXTH STREET RACHAEL GILBERTSON Initial Cert: 12/14/2000 GREEN BAY, WI 54304 [email protected] Cert Eff: 01/01/2021 County: Brown Phone:(920) 497-6161 Cert Exp: 12/31/2022 Surveyor: Renee DeWitt Fax: (920) 498-0476
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ASHWAUBENON HIGH SCHOOL, 2391 S RIDGE RD, ASHWAUBENON, WI 54304 01/01/2021 12/31/2022 PARKVIEW MIDDLE SCHOOL, 955 WILLARD DR, ASHWAUBENON, WI 54304 01/01/2021 12/31/2022 VALLEY VIEW ELEMENTARY SCHOOL, 2200 TRUE LN, ASHWAUBENON, WI 54304 01/01/2021 12/31/2022 PIONEER ELEMENTARY SCHOOL, 1360 PONDEROSA AVE, GREEN BAY, WI 54313 01/01/2021 12/31/2022
09/28/2021 Page 16 of 222 Mental Health Program Directory By County, City, and Provider Name
INNOVATIVE SERVICES WELLNESS CENTER 3270
1234 MAIN STREET, 3RD FL ABBY BAUMGART Initial Cert: 12/17/2019 GREEN BAY, WI 54302 [email protected] Cert Eff: 01/01/2021 County: Brown Phone:(920) 241-2628 Cert Exp: 12/31/2022 Surveyor: Renee DeWitt Fax: (920) 273-3371
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 INNOVATIVE SERVICES WELLNESS CENTER - KEWAUNEE, 1304 SE FIRST ST, KEWAUNEE, WI 01/01/2021 12/31/2022 54216 2 INNOVATIVE SVS WELLNESS-LA CROSSE, 1052 OAK FOREST DR, STE 360, ONALASKA, WI 54650 01/01/2021 12/31/2022 2 INNOVATIVE SVS WELLNESS-SHAWANO, 815 E MAUER STREET, SHAWANO, WI 54166 01/01/2021 12/31/2022 2 INNOVATIVE SVS WELLNESS-STEVENS PT, 1001 BRILOWSKI ROAD, STEVENS POINT, WI 54482 01/01/2021 12/31/2022
3 SAWYER ELEMENTARY SCHOOL, 60 WILLOW DR, STURGEON BAY, WI 54235 01/01/2021 12/31/2022 3 SUNRISE ELEMENTARY SCHOOL, 1414 RHODE ISLAND ST, STURGEON BAY, WI 54235 01/01/2021 12/31/2022
JACKIE NITSCHKE CENTER, INC 2988
621 E WALNUT STREET ANNA JOHNSEN Initial Cert: 01/01/2013 GREEN BAY, WI 54301 [email protected] Cert Eff: 07/01/2021 County: Brown Phone:(920) 435-2093 Cert Exp: 12/31/2022 Surveyor: Renee DeWitt Fax: (920) 435-2580
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 JACKIE NITSCHKE CENTER, INC. ADMIN OFFICES & FAM E, 700 CHERRY STREET, GREEN BAY, WI 07/01/2021 12/31/2022 54301
KA'NI KUHLI'YO FAMILY CENTER 1454
2640 WEST POINT ROAD MARI KRIESCHER Initial Cert: 03/11/1993 GREEN BAY, WI 54303 [email protected] Cert Eff: 02/01/2021 County: Brown Phone:(920) 490-3790 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (920) 490-3883
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ANNA JOHN RESIDENT CENTERED CARE COMMUNITY, 2901 S OVERLAND, ONEIDA, WI 54155 02/01/2021 01/31/2023 1 ONEIDA COMMUNITY HEALTH CENTER, 525 AIRPORT DRIVE, ONEIDA, WI 54155 02/01/2021 01/31/2023 1 ONEIDA NATION VETERAN'S DEPARTMENT, 134 RIVERDALE DR., ONEIDA, WI 54155 02/01/2021 01/31/2023
3 ONEIDA NATION ELEMENTARY SCHOOL, N7125 SEMINARY ROAD, ONEIDA, WI 54155 02/01/2021 01/31/2023 3 ONEIDA NATION HIGH SCHOOL, N7210 SEMINARY ROAD, ONEIDA, WI 54155 02/01/2021 01/31/2023 3 SEYMOUR HIGH SCHOOL SYSTEM, 10 CIRCLE DRIVE, SEYMOUR, WI 54165 02/01/2021 01/31/2023
09/28/2021 Page 17 of 222 Mental Health Program Directory By County, City, and Provider Name
KIMBERLEY WELK AND ASSOCIATES LLC 3025
926 WILLARD DR #136 KIMBERLEY WELK Initial Cert: 04/11/2014 GREEN BAY, WI 54301 [email protected] Cert Eff: 07/01/2020 County: Brown Phone:(920) 461-5820 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (888) 449-6342
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 KIMBERLEY WELK AND ASSOCIATES LLC, 935 S 8TH STREET STE 102, MANITOWOC, WI 54220 07/01/2020 03/31/2022
3 LAONA HIGH SCHOOL, 5216 FOREST AVE, BLACKWELL, WI 54541 07/14/2021 03/31/2022 3 GRESHAM HIGH SCHOOL, 501 SCHABOW ST, GRESHAM, WI 54128 08/09/2021 03/31/2022 3 KIEL HIGH SCHOOL, 210 RAIDER HEIGHTS, KIEL, WI 53042 07/01/2020 03/31/2022 3 KIEL MIDDLE SCHOOL, 502 PAINE ST, KIEL, WI 53042 07/01/2020 03/31/2022 3 FRANKLIN ELEMENTARY SCHOOL, 800 S 35TH ST, MANITOWOC, WI 54220 07/01/2020 03/31/2022 3 JACKSON ELEMENTARY SCHOOL, 1201 N 18TH ST, MANITOWOC, WI 54220 07/01/2020 03/31/2022 3 RIVERVIEW ELEMENTARY SCHOOL, 4400 MICHIGAN AVE, MANITOWOC, WI 54220 08/18/2020 03/31/2022 3 OCONTO ELEMENTARY SCHOOL, 810 SCHERER AVE, OCONTO, WI 54153 08/16/2021 03/31/2022 3 OCONTO HIGH SCHOOL, 1717 SUPERIOR AVE, OCONTO, WI 54153 08/16/2021 03/31/2022 3 OCONTO MIDDLE SCHOOL, 400 MICHIGAN AVE, OCONTO, WI 54153 08/16/2021 03/31/2022 3 REEDSVILLE ELEMENTARY/MIDDLE SCHOOL, 350 PARK ST, REEDSVILLE, WI 54230 07/01/2020 03/31/2022 3 REEDSVILLE HIGH SCHOOL, 340 MANITOWOC ST, REEDSVILLE, WI 54230 07/01/2020 03/31/2022 3 VALDERS ELEMENTARY SCHOOL, 331 W WILSON, VALDERS, WI 54245 07/01/2020 03/31/2022 3 VALDERS MIDDLE/HIGH SCHOOL, 201 W WILSON, VALDERS, WI 54245 07/01/2020 03/31/2022 3 WABENO ELEMENTARY SCHOOL, 4346 MILL LN, WABENO, WI 54566 08/23/2021 03/31/2022 3 WABENO HIGH SCHOOL, 4325 NORTH BRANCH ST, WABENO, WI 54566 08/23/2021 03/31/2022
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY – GREEN BAY 3197
123 S VAN BUREN JACKIE MAURER Initial Cert: 02/01/2018 GREEN BAY, WI 54301 [email protected] Cert Eff: 02/01/2021 County: Brown Phone:(920) 634-2903 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (844) 380-1192
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
POWER FOR CHANGE, LLC 2929
123 N OAKLAND AVE STEVE SHEFCHIK Initial Cert: 10/13/2010 GREEN BAY, WI 54303 [email protected] Cert Eff: 11/01/2019 County: Brown Phone:(920) 770-4088 Cert Exp: 10/31/2021 Surveyor: Renee DeWitt Fax: (651) 707-0026
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 POWER FOR CHANGE, LLC, 2448 S 102ND ST, STE 155, WEST ALLIS, WI 53227 03/13/2020 10/31/2021
09/28/2021 Page 18 of 222 Mental Health Program Directory By County, City, and Provider Name
SBH GREEN BAY LLC DBA WILLOW CREEK BEHAVIORAL HEALTH 3168
1351 ONTARIO RD ALISON DENIL Initial Cert: 01/10/2017 GREEN BAY, WI 54311 [email protected] Cert Eff: 02/01/2021 County: Brown Phone:(920) 328-1220 Cert Exp: 01/31/2022 Surveyor: Renee DeWitt Fax: (920) 469-7213
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 02/01/2021 01/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 02/01/2021 01/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 02/01/2021 01/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2021 01/31/2022 NO BRANCH LOCATIONS
SPECTRUM BEHAVIORAL HEALTH LLC 3331
1496 BELLEVUE ST, SUITE 101 CAITLIN CARMODY Initial Cert: 09/02/2021 GREEN BAY, WI 54311 [email protected] Cert Eff: 09/02/2021 County: Brown Phone:(920) 784-2644 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (920) 784-2655
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/02/2021 08/31/2023 NO BRANCH LOCATIONS
VILLA HOPE COMMUNITY SUPPORT PROGRAM OF BROWN COUNTY 1965
1100 GUNS ROAD MOLLIE TOONEN Initial Cert: 02/06/1996 GREEN BAY, WI 54311 [email protected] Cert Eff: 03/01/2020 County: Brown Phone:(920) 469-7030 Cert Exp: 02/28/2022 Surveyor: Renee DeWitt Fax: (920) 469-5599
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
09/28/2021 Page 19 of 222 Mental Health Program Directory By County, City, and Provider Name
BURNETT SIREN ACCESS INC COMMUNITY SUPPORT PROGRAM 2633
24248 STATE ROAD 35/70 UNIT D TERRI BOLLINGER Initial Cert: 01/01/2006 SIREN, WI 54872 [email protected] Cert Eff: 01/01/2020 County: Burnett Phone:(715) 563-7776 Cert Exp: 12/31/2021 Surveyor: Rena Andersen Fax: (715) 349-7205
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
BURNETT COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT/ACCESS, INC 2630
7410 COUNTY K, #280 BYRON HOPKE Initial Cert: 12/01/2005 SIREN, WI 54872 [email protected] Cert Eff: 12/01/2020 County: Burnett Phone:(715) 349-7600 Cert Exp: 11/30/2022 Surveyor: Rena Andersen Fax: (715) 349-2140 Crisis Intervention Services Regional Designation Begin End Lead AURORA COMMUNITY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
FAMILIES FIRST COUNSELING CENTER, LLC 2493
24178 FIRST AVE SO, SUITE 2 CATHERINE HAYMAN Initial Cert: 01/08/2004 SIREN, WI 54872 [email protected] Cert Eff: 02/01/2021 County: Burnett Phone:(715) 349-8913 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (715) 349-8918
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates FREDERIC 6-12 SCHOOL, 1437 CLAM FALLS DR, FREDERIC, WI 54837 02/01/2021 01/31/2023 GRANTSBURG ELEMENTARY SCHOOL, 475 E JAMES AVE, GRANTSBURG, WI 54840 02/01/2021 01/31/2023 GRANTSBURG HIGH SCHOOL, 480 E JAMES AVE, GRANTSBURG, WI 54840 02/01/2021 01/31/2023 GRANTSBURG MIDDLE SCHOOL, 500 E JAMES AVE, GRANTSBURG, WI 54840 02/01/2021 01/31/2023 SIREN SCHOOLS K-12, 24022 4TH AVE, SIREN, WI 54872 02/01/2021 01/31/2023 SPOONER ELEMENTARY, 1821 SCHIBNER ST, SPOONER, WI 54801 02/01/2021 01/31/2023 WEBSTER 5-12 SCHOOL, 7564 ADLER ST W, WEBSTER, WI 54893 02/01/2021 01/31/2023 WEBSTER ELEMENTARY SCHOOL, 7364 ALDER ST E, WEBSTER, WI 54893 02/01/2021 01/31/2023
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - SIREN 2290
24996 STATE ROAD 35 JACKIE MAURER Initial Cert: 02/12/2001 SIREN, WI 54872 [email protected] Cert Eff: 04/01/2021 County: Burnett Phone:(715) 349-2829 Cert Exp: 03/31/2023 Surveyor: Rena Andersen Fax: (715) 349-2737
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 20 of 222 Mental Health Program Directory By County, City, and Provider Name
WEBSTER ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC 2217
4404 STATE RD 70 ANA WINTON Initial Cert: 05/01/2000 WEBSTER, WI 54893 [email protected] Cert Eff: 08/01/2020 County: Burnett Phone:(715) 349-8554 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 349-8528
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ROUND LAKE CLINIC, 2230 - 60TH AVENUE, LUCK, WI 54853 08/01/2020 04/30/2022
09/28/2021 Page 21 of 222 Mental Health Program Directory By County, City, and Provider Name
CALUMET CHILTON CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES 1120
206 COURT STREET KRISTI LECLAIR Initial Cert: 10/01/1975 CHILTON, WI 53014 [email protected] Cert Eff: 10/01/2020 County: Calumet Phone:(920) 849-1400 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (920) 849-1468 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2020 06/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CALUMET COUNTY DEPT OF HUMAN SERVICES, 2306 S. ONEIDA STREET, APPLETON, WI 54915 10/01/2020 06/30/2022
CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES CSP 2244
206 COURT STREET KRISTI LECLAIR Initial Cert: 07/01/2000 CHILTON, WI 53014 [email protected] Cert Eff: 10/01/2020 County: Calumet Phone:(920) 849-1400 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (920) 849-1468
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2674
206 COURT STREET KRISTI LECLAIR Initial Cert: 06/13/2006 CHILTON, WI 53014 [email protected] Cert Eff: 07/01/2021 County: Calumet Phone:(920) 849-1400 Cert Exp: 06/30/2023 Surveyor: Heather Lom Fax: (920) 849-1468
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 CCDHHS - APPLETON OFFICE, 2306 S ONEIDA ST, APPLETON, WI 54915 07/01/2021 06/30/2023
09/28/2021 Page 22 of 222 Mental Health Program Directory By County, City, and Provider Name
KAUKAUNA NEW WELLNESS ASSOCIATES, INC. 1669
1941 LEHRER LN PATTY HOWARD Initial Cert: 06/01/1993 KAUKAUNA, WI 54130 [email protected] Cert Eff: 06/01/2021 County: Calumet Phone:(920) 497-6200 Cert Exp: 05/31/2023 Surveyor: Renee DeWitt Fax: (920) 497-3135
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 NEW WELLNESS ASSOCIATED, INC, 2733 S RIDGE RD, GREEN BAY, WI 54304 06/01/2021 05/31/2023
09/28/2021 Page 23 of 222 Mental Health Program Directory By County, City, and Provider Name
CHIPPEWA CHIPPEWA FALLS MARRIAGE & FAMILY HEALTH SERVICES, LTD. 2424
405 ISLAND STREET JENNIFER SCHULZ-JOHNSTON Initial Cert: 01/01/2003 CHIPPEWA FALLS, WI 54729 [email protected] Cert Eff: 05/01/2021 County: Chippewa Phone:(715) 726-9208 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (715) 726-8731
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 05/01/2021 04/30/2022 NO BRANCH LOCATIONS
WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM 3066
711 N BRIDGE STREET JESSICA BARRICKMAN Initial Cert: 05/01/2015 CHIPPEWA FALLS, WI 54729 [email protected] Cert Eff: 01/01/2021 County: Chippewa Phone:(715) 738-2585 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (715) 726-4560 Crisis Intervention Services Regional Designation Begin End Lead WWRWC CRISIS SERVICE: BUFFALO, CHIPPEWA, PEPIN 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI 01/01/2021 04/30/2022 54610 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 - 7TH AVE. WEST, DURAND, WI 54736 01/01/2021 04/30/2022
WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM - CSP 3064
711 N BRIDGE STREET JESSICA BARRICKMAN Initial Cert: 05/01/2015 CHIPPEWA FALLS, WI 54729 [email protected] Cert Eff: 01/01/2021 County: Chippewa Phone:(715) 738-2585 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (715) 726-7736
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI 01/01/2021 04/30/2022 54610 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 - 7TH AVE. WEST, DURAND, WI 54736 01/01/2021 04/30/2022
09/28/2021 Page 24 of 222 Mental Health Program Directory By County, City, and Provider Name
WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS 3065
711 N BRIDGE STREET JESSICA BARRICKMAN Initial Cert: 04/01/2015 CHIPPEWA FALLS, WI 54729 [email protected] Cert Eff: 04/01/2021 County: Chippewa Phone:(715) 728-2585 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (715) 726-7816
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 04/01/2021 03/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S SECOND ST, ALMA, WI 54610 04/01/2021 03/31/2023 2 POLK COUNTY HUMAN SERVICES DEPT, 100 POLK COUNTY PLAZA, STE 50, BALSAM LAKE, WI 04/01/2021 03/31/2023 54810 2 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 7TH AVE WEST, DURAND, WI 54736 04/01/2021 03/31/2023 2 PIERCE COUNTY DEPT OF HUMAN SERVICES, 412 W KINNE ST, ELLSWORTH, WI 54011 04/01/2021 03/31/2023 2 RUSK COUNTY DEPT OF HEALTH & HUMAN SERVICES, 311 E MINER ST, LADYSMITH, WI 54848 04/01/2021 03/31/2023 2 DUNN COUNTY DEPT OF HUMAN SERVICES, 3001 US HWY 12 E, STE 160, MENOMONIE, WI 54751 04/01/2021 03/31/2023 2 WASHBURN COUNTY DEPT OF HEALTH AND HUMAN SERVICES, 110 4TH AVENUE, SHELL LAKE, WI 04/01/2021 03/31/2023 54871 2 BURNETT COUNTY DEPT OF HUMAN SERVICES, 7410 CTY RD K, SIREN, WI 54872 04/01/2021 03/31/2023
09/28/2021 Page 25 of 222 Mental Health Program Directory By County, City, and Provider Name
CLARK NEILLSVILLE CLARK COUNTY COMMUNITY SERVICES 1201
517 COURT STREET RM 503 SUE VOIGT Initial Cert: 01/01/1984 NEILLSVILLE, WI 54456 [email protected] Cert Eff: 01/01/2020 County: Clark Phone:(715) 743-5208 Cert Exp: 12/31/2021 Surveyor: Roderick Senn Fax: (715) 743-5209 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 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 CLARK COUNTY REHABILITATION AND LIVING CENTER, W4266 STATE HWY 29, OWEN, WI 54460 01/01/2020 12/31/2021
3 GRANTON SCHOOL DISTRICT, 217 N. MAIN STREET, GRANTON, WI 54436 01/01/2020 12/31/2021 3 GREENWOOD ELEMENTARY, 700 EAST DIVISION STREET, GREENWOOD, WI 54437 01/01/2020 12/31/2021 3 GREENWOOD MIDDLE/HIGH SCHOOL, 306 WEST CENTRAL AVENUE, GREENWOOD, WI 54437 01/01/2020 12/31/2021 3 LOYAL SCHOOL DISTRICT, 514 WEST CENTRAL STREET, LOYAL, WI 54446 01/01/2020 12/31/2021 3 NEILLSVILLE ELEMENTARY SCHOOL, 504 EAST 5TH STREET, NEILLSVILLE, WI 54456 01/01/2020 12/31/2021 3 NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456 01/01/2020 12/31/2021 3 OWEN-WITHEE SHOOL DISTRICT, 832 WEST 3RD STREET, OWEN, WI 54460 01/01/2020 12/31/2021 3 SCHOOL DISTRICT OF THORP, 605 SOUTH CLARK STREET, THORP, WI 54771 01/01/2020 12/31/2021
CLARK COUNTY COMMUNITY SERVICES 3093
517 COURT STREET, ROOM 503 SUE VOIGT Initial Cert: 09/01/2015 NEILLSVILLE, WI 54456 [email protected] Cert Eff: 09/01/2020 County: Clark Phone:(715) 743-5208 Cert Exp: 08/31/2022 Surveyor: Roderick Senn Fax: (715) 743-5209
CCS Affiliaton:CCS OF CLARK AND TREMPEALEAU COUNTIES Begin: 09/01/2015
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2020 08/31/2022 NO BRANCH LOCATIONS
CLARK COUNTY COMMUNITY SUPPORT PROGRAM 1202
517 COURT ST, ROOM 503 SUE VOIGT Initial Cert: 04/01/1991 NEILLSVILLE, WI 54456 [email protected] Cert Eff: 12/01/2019 County: Clark Phone:(715) 743-5205 Cert Exp: 11/30/2021 Surveyor: Roderick Senn Fax: (715) 743-5209
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
09/28/2021 Page 26 of 222 Mental Health Program Directory By County, City, and Provider Name
OWEN LIVING WELL MENTAL HEALTH CLINIC, LLC 3208
112 N CENTRAL AVE JESSE KOPS Initial Cert: 05/01/2018 OWEN, WI 54460 [email protected] Cert Eff: 05/01/2021 County: Clark Phone:(715) 229-0330 Cert Exp: 04/30/2023 Surveyor: Roderick Senn Fax: (715) 229-0331
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 27 of 222 Mental Health Program Directory By County, City, and Provider Name
COLUMBIA PORTAGE ASPEN FAMILY COUNSELING 1066
2639 NEW PINERY ROAD, #1 BARRY ERATH Initial Cert: 01/01/2015 PORTAGE, WI 53901 [email protected] Cert Eff: 07/01/2021 County: Columbia Phone:(608) 742-5020 Cert Exp: 12/31/2022 Surveyor: Tina Dary Fax: (608) 742-3641
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ASPEN FAMILY COUNSELING, 120 3RD STREET, BARABOO, WI 53913 07/01/2021 12/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BARABOO HIGH SCHOOL, 1201 DRAPER ST, BARABOO, WI 53913 07/01/2021 12/31/2022 CAMBRIA FRIELAND SCHOOL, 410 E EDGEWATER ST, CAMBRIA, WI 53923 07/01/2021 12/31/2022 COLUMBUS SCHOOLS, 200 W SCHOOL ST, COLUMBUS, WI 53925 07/01/2021 12/31/2022 LODI SCHOOLS, 1100 SAUK ST, LODI, WI 53555 07/01/2021 12/31/2022 MONTELLO SCHOOLS, 222 FOREST LN, MONTELLO, WI 53949 07/01/2021 12/31/2022 PARDEEVILLE MIDDLE AND HIGH SCHOOL, 120 OAK ST, PARDEEVILLE, WI 53954 07/01/2021 12/31/2022 POYNETTE SCHOOLS, 108 N CLEVELAND ST, POYNETTE, WI 53955 07/01/2021 12/31/2022 RANDOLPH SCHOOLS, 110 MEADOWOOD DR, RANDOLPH, WI 53956 07/01/2021 12/31/2022 WISCONSIN DELLS SCHOOLS, 520 RACE ST, WISCONSIN DELLS, WI 53965 07/01/2021 12/31/2022
COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES 2898
111 E MULLETT ST STEPHANIE NICKEL Initial Cert: 04/01/2010 PORTAGE, WI 53901 [email protected] Cert Eff: 04/01/2020 County: Columbia Phone:(608) 742-9227 Cert Exp: 03/31/2022 Surveyor: Tina Dary Fax: (608) 742-9700
CCS Affiliaton:WISCONSIN RIVER CCS COLLABORATION Begin: 07/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2020 03/31/2022 NO BRANCH LOCATIONS
COLUMBIA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES 2670
111 E MULLETT ST ANGELA SMITH Initial Cert: 07/01/2006 PORTAGE, WI 53901 [email protected] Cert Eff: 11/01/2019 County: Columbia Phone:(608) 742-9227 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 742-9700 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 HOME YOUTH DIVERSION PROGRAM 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 28 of 222 Mental Health Program Directory By County, City, and Provider Name
COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS 2149
2901 HUNTERS TRAIL DR. JILL BAURES Initial Cert: 10/08/1999 PORTAGE, WI 53901 [email protected] Cert Eff: 10/01/2020 County: Columbia Phone:(608) 742-5518 Cert Exp: 06/30/2022 Surveyor: Tina Dary Fax: (608) 742-4087
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 1002 LINCOLN AVE, BARABOO, WI 53913 10/01/2020 06/30/2022 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 1343 PARK AVE, COLUMBUS, WI 53925 10/01/2020 06/30/2022 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 2702 INTERNATIONAL LN #102, MADISON, WI 53704 10/01/2020 06/30/2022 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 50 PRAIRIE AVE, PRAIRIE DU SAC, WI 53578 10/01/2020 06/30/2022 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 710 NORTH WEBB AVE STE 400, REEDSBURG, WI 10/01/2020 06/30/2022 53959 2 COMM SERV ASSOC DBA PAUQUETTE CTR, 23295 US HWY 14 WEST, RICHLAND CENTER, WI 53581 10/01/2020 06/30/2022 2 COMMUNITY SERVICE ASSOCIATES DBA PAUQUETTE CENTER, 1221 INNOVATION DR STE 221, 12/17/2020 06/30/2022 WHITEWATER, WI 53190
COMPASS COUNSELING 2905
1508 NEW PINERY RD SARAH KRAVICK Initial Cert: 05/01/2010 PORTAGE, WI 53901 [email protected] Cert Eff: 05/01/2021 County: Columbia Phone:(608) 745-4900 Cert Exp: 04/30/2023 Surveyor: Tina Dary Fax: (608) 745-4990
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 1 COMPASS COUNSELING - BRAKEBUSH, N4993 6TH DRIVE, WESTFIELD, WI 53964 05/01/2021 04/30/2023
3 RIO MIDDLE SCHOOL/HIGH SCHOOL, 411 CHURCH ST, RIO, WI 53960 05/01/2021 04/30/2023
JOURNEY MENTAL HEALTH CENTER CSP - COLUMBIA CO 3159
1440 E WISCONSIN AVE SARAH NILES Initial Cert: 10/31/2016 PORTAGE, WI 53901 [email protected] Cert Eff: 11/01/2019 County: Columbia Phone:(608) 745-9720 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 745-9721
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2019 11/29/2019 NO BRANCH LOCATIONS
TRANSITIONS BEHAVIORAL HEALTH LLC 2915
317 DE WITT ST JESSICA BECKETT Initial Cert: 07/01/2010 PORTAGE, WI 53901 [email protected] Cert Eff: 07/01/2021 County: Columbia Phone:(608) 566-3813 Cert Exp: 06/30/2023 Surveyor: Tina Dary Fax: (608) 745-1757
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 29 of 222 Mental Health Program Directory By County, City, and Provider Name
CRAWFORD PRAIRIE DU CHIEN CRAWFORD COUNTY COMMUNITY SUPPORT PROGRAM 2376
225 N BEAUMONT ROAD #326 DANIEL MCWILLIAMS Initial Cert: 05/01/2002 PRAIRIE DU CHIEN, WI 53821 [email protected] Cert Eff: 04/01/2020 County: Crawford Phone:(608) 326-0248 Cert Exp: 03/31/2022 Surveyor: Tina Dary Fax: (608) 326-4395
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2020 03/31/2022 NO BRANCH LOCATIONS
CRAWFORD COUNTY HEALTH & HUMAN SERVICES DEPARTMENT 1259
225 N BEAUMONT ROAD #326 DANIEL MCWILLIAMS Initial Cert: 10/01/1975 PRAIRIE DU CHIEN, WI 53821 [email protected] Cert Eff: 04/01/2020 County: Crawford Phone:(608) 326-0248 Cert Exp: 03/31/2022 Surveyor: Tina Dary Fax: (608) 326-4395 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020
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 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2020 03/31/2022 NO BRANCH LOCATIONS
CROSSING RIVERS HEALTH - CENTER FOR BEHAVIORAL HEALTH 3299
37868 US HWY 18 LACIE ANTHONY Initial Cert: 08/07/2020 PRAIRIE DU CHIEN, WI 53821 [email protected] Cert Eff: 08/07/2020 County: Crawford Phone:(608) 357-2540 Cert Exp: 07/31/2021 Surveyor: Tina Dary Fax: (608) 357-2150
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/07/2020 07/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 30 of 222 Mental Health Program Directory By County, City, and Provider Name
DANE BELLEVILLE FOUNDATIONS COUNSELING CENTER, LLC 2508
629 RIVER ST, STE C ALISA KELLY-MARTINA Initial Cert: 04/01/2004 BELLEVILLE, WI 53508 [email protected] Cert Eff: 04/01/2021 County: Dane Phone:(608) 445-0710 Cert Exp: 03/31/2023 Surveyor: Tina Dary Fax: (608) 424-9099
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 FOUNDATIONS COUNSELING CENTER - BEAVER DAM, 1807 N CENTER ST SUITE 103, BEAVER DAM, 04/01/2021 03/31/2023 WI 53916 1 FOUNDATIONS COUNSELING CENTER - LODI, 109 FIRST ST., LODI, WI 53555 04/01/2021 03/31/2023
FITCHBURG ABEGGLEN COUNSELING & CONSULTING, LLC 3244
2940 CHAPEL VALLEY RD STE 2 JESSICA ABEGGLEN Initial Cert: 01/31/2019 FITCHBURG, WI 53711 [email protected] Cert Eff: 02/01/2020 County: Dane Phone:(608) 709-9672 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 416-1535
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ABEGGLEN COUNSELING & CONSULTING, LLC, 740 REGENT STREET SUITE 201, MADISON, WI 08/01/2020 01/31/2022 53715 3 MADISON EAST HIGH SCHOOL, 2222 EAST WASHINGTON AVE, MADISON, WI 53711 02/01/2020 01/31/2022
NORTHERN ROOTS THERAPY CENTER 3273
2960 TRIVERTON PIKE DR MARGARET BESTER Initial Cert: 02/01/2020 FITCHBURG, WI 53711 [email protected] Cert Eff: 02/01/2021 County: Dane Phone:(608) 234-1224 Cert Exp: 01/31/2023 Surveyor: Tina Dary Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 MOONTREE BUILDING, 401 WISCONSIN AVE, MADISON, WI 53703 02/01/2021 01/31/2023
2 NORTHERN ROOTS THERAPY CENTER, LLC - MIDDLETON, 6702 STONEFIELD ROAD, MIDDLETON, 02/01/2021 01/31/2023 WI 53562
09/28/2021 Page 31 of 222 Mental Health Program Directory By County, City, and Provider Name
MADISON ANESIS CENTER FOR MARRIAGE AND FAMILY THERAPY 3259
6417 ODANA RD STE 5 MYRA MCNAIR Initial Cert: 08/28/2019 MADISON, WI 53719 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 268-6530 Cert Exp: 08/31/2022 Surveyor: Tina Dary Fax: (608) 709-1774
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NORTHSIDE, 2801 INTERNATIONAL LANE, MADISON, WI 53704 01/01/2021 08/31/2022
2 IN HOME THERAPY, 6506 SCHROEDER ROAD STES 201-202, MADISON, WI 53719 05/04/2021 08/31/2022
ARC COMMUNITY SERVICES INC MADISON 1053
1409 EMIL STREET #100 LAURA FABICK Initial Cert: 03/01/1995 MADISON, WI 53713 [email protected] Cert Eff: 03/01/2021 County: Dane Phone:(608) 283-6426 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 283-6374
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 03/01/2021 02/28/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1188
1716 FORDEM AVENUE BROOKE LUEBKE Initial Cert: 03/01/1981 MADISON, WI 53704 [email protected] Cert Eff: 03/01/2021 County: Dane Phone:(608) 221-3511 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 221-3514
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
CONNECTIONS COUNSELING, LLC 3322
5005 UNIVERSITY AVE, SUITE 100 CHARLES CALLENDER Initial Cert: 04/27/2021 MADISON, WI 53705 [email protected] Cert Eff: 04/27/2021 County: Dane Phone:(608) 233-2100 Cert Exp: 03/31/2023 Surveyor: Tina Dary Fax: (608) 233-2101
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/27/2021 03/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/27/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 32 of 222 Mental Health Program Directory By County, City, and Provider Name
DANE COUNTY HUMAN SERVICES CCS 3036
1202 NORTHPORT DRIVE JULIE MEISTER Initial Cert: 07/01/2015 MADISON, WI 53704 [email protected] Cert Eff: 07/01/2021 County: Dane Phone:(608) 242-6200 Cert Exp: 06/30/2023 Surveyor: Tina Dary Fax: (608) 283-2994
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
DANE COUNTY HUMAN SERVICES DEPT./JOURNEY MENTAL HEALTH CENTER 2646
702 WEST MAIN ST HANNAH FLANAGAN Initial Cert: 03/01/2006 MADISON, WI 53715 [email protected] Cert Eff: 03/01/2021 County: Dane Phone:(608) 280-2437 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 280-2707 Crisis Intervention Services Regional Designation Begin End Lead SINGLE COUNTY CCS REGION - DANE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
FAMILY SERVICE MADISON, INC. 1327
128 E OLIN AVENUE, #100 JENNIE MCCANN Initial Cert: 04/01/1977 MADISON, WI 53713 [email protected] Cert Eff: 12/09/2020 County: Dane Phone:(608) 316-1135 Cert Exp: 09/30/2021 Surveyor: Tina Dary Fax: (608) 252-1333
Services Adm Code Service Begin/End Dates CSAS-PREVENTION DHS 75.04 12/09/2020 09/30/2021 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 12/09/2020 09/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/09/2020 09/30/2021 NO BRANCH LOCATIONS
INSIGHT COUNSELING & WELLNESS LLC 3028
2021 ATWOOD AVE ABBY KEARNS Initial Cert: 06/01/2014 MADISON, WI 53704 [email protected] Cert Eff: 06/01/2021 County: Dane Phone:(608) 244-4859 Cert Exp: 05/31/2023 Surveyor: Tina Dary Fax: (608) 244-6809
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 INSIGHT COUNSELING & WELLNESS, LLC, 2002 ATWOOD AVE SUITE 205, MADISON, WI 53704 06/01/2021 05/31/2023
09/28/2021 Page 33 of 222 Mental Health Program Directory By County, City, and Provider Name
JOURNEY MENTAL HEALTH CENTER 1596
49 KESSEL COURT NICHOLE WRIGHT Initial Cert: 10/01/1975 MADISON, WI 53711 [email protected] Cert Eff: 03/01/2020 County: Dane Phone:(608) 280-2437 Cert Exp: 02/28/2022 Surveyor: Tina Dary Fax: (608) 280-2707
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 2 JOURNEY MENTAL HEALTH CENTER, INC (JOURNEY EAST), 1320 MENDOTA ST, MADISON, WI 53714 03/01/2020 02/28/2022
JOURNEY MENTAL HEALTH CENTER - FORWARD SOLUTIONS CSP 1598
1320 MENDOTA ST SUITE 120 CHRISTINE GOERGEN Initial Cert: 09/01/1990 MADISON, WI 53714 [email protected] Cert Eff: 11/01/2020 County: Dane Phone:(608) 280-3180 Cert Exp: 10/31/2022 Surveyor: Tina Dary Fax: (608) 280-3185
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
JOURNEY MENTAL HEALTH CENTER GATEWAY COMMUNITY SUPPORT PROGRAM 1599
208 E OLIN AVE STE 205 STACY KLEIN Initial Cert: 09/01/1990 MADISON, WI 53713 [email protected] Cert Eff: 02/01/2021 County: Dane Phone:(608) 280-3150 Cert Exp: 01/31/2023 Surveyor: Tina Dary Fax: (608) 237-2690
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
JOURNEY MENTAL HEALTH CENTER-COMMUNITY TREATMENT ALTERNATIVES CSP 1593
2000 FORDEM AVE MARK PINKERTON Initial Cert: 02/01/1992 MADISON, WI 53704 [email protected] Cert Eff: 02/01/2020 County: Dane Phone:(608) 280-2740 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 280-2775
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
MADISON TRAUMA THERAPY LLC 3318
4785 HAYES ROAD STE 201 DEBRA MILLMAN Initial Cert: 01/25/2021 MADISON, WI 53704 [email protected] Cert Eff: 01/25/2021 County: Dane Phone:(608) 509-9287 Cert Exp: 12/31/2021 Surveyor: Tina Dary Fax: (608) 630-8089
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/25/2021 12/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 34 of 222 Mental Health Program Directory By County, City, and Provider Name
MARRIAGE & FAMILY SOLUTIONS LLC 2738
7818 BIG SKY DRIVE #101 CRYSTAL D'ORAZIO Initial Cert: 06/08/2007 MADISON, WI 53719 [email protected] Cert Eff: 09/01/2020 County: Dane Phone:(608) 203-6267 Cert Exp: 05/31/2022 Surveyor: Tina Dary Fax: (608) 203-6696
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022 NO BRANCH LOCATIONS
MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM 1013
202 S. PARK STREET MONICA CASE Initial Cert: 01/01/1984 MADISON, WI 53715 [email protected] Cert Eff: 12/01/2020 County: Dane Phone:(608) 417-5346 Cert Exp: 11/30/2022 Surveyor: Tina Dary Fax: (608) 417-5334
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
MERITER NEWSTART OUTPATIENT CLINIC 1617
1015 GAMMON LANE SARAH VALENCIA Initial Cert: 01/01/1988 MADISON, WI 53719 [email protected] Cert Eff: 12/01/2020 County: Dane Phone:(608) 417-5346 Cert Exp: 11/30/2022 Surveyor: Tina Dary Fax: (608) 417-5334
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
MERITER'S CHILD & ADOLESCENT PSYCHIATRIC HOSPITAL 1668
8102 WELLNESS WAY MONICA CASE Initial Cert: 01/01/1984 MADISON, WI 53719 [email protected] Cert Eff: 12/01/2020 County: Dane Phone:(608) 417-5346 Cert Exp: 11/30/2022 Surveyor: Tina Dary Fax: (608) 417-5334
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 12/01/2020 11/30/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
NORTHSTAR COUNSELING CENTER 1685
6506 SCHROEDER RD HEATHER PATTI Initial Cert: 11/01/1991 MADISON, WI 53711 [email protected] Cert Eff: 10/30/2020 County: Dane Phone:(608) 270-1960 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 270-1965
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 10/30/2020 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 35 of 222 Mental Health Program Directory By County, City, and Provider Name
OPEN DOOR CENTER FOR CHANGE LLC 2026
6502 GRAND TETON PLAZA #102 BRUCE ALLEN Initial Cert: 09/01/1996 MADISON, WI 53719 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 827-7220 Cert Exp: 08/31/2022 Surveyor: Tina Dary Fax: (608) 827-7223
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 OPEN DOOR FOR CHANGE, 2820 WALTON COMMONS, SUITE 128, MADISON, WI 53718 01/01/2021 08/31/2022
ORION FAMILY SERVICES, INC. 2309
6333 ODANA ROAD, #20 STACEY PARKE Initial Cert: 07/12/2001 MADISON, WI 53719 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 270-2511 Cert Exp: 07/31/2022 Surveyor: Tina Dary Fax: (608) 270-0467
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ORION FAMILY SERVICES, 1725 15TH STREET, MONROE, WI 53566 01/01/2021 07/31/2022
PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT (PACT) 1750
600 WILLIAMSON STREET, #A-B JANA LANE FREY Initial Cert: 09/01/1989 MADISON, WI 53703 [email protected] Cert Eff: 10/01/2019 County: Dane Phone:(608) 266-0721 Cert Exp: 09/30/2021 Surveyor: Tina Dary Fax: (608) 266-3638
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
REFLECTIONS MENTAL HEALTH, LLC 3274
2802 COHO STE 203 REBECCA MAHAN-STRUPP Initial Cert: 12/23/2019 MADISON, WI 53713 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 436-0921 Cert Exp: 12/31/2022 Surveyor: Tina Dary Fax: (608) 531-2697
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
REGENT MENTAL HEALTH GROUP 1786
700 RAYOVAC DRIVE, STE 103 DIANE KOHRS Initial Cert: 09/01/1979 MADISON, WI 53711 [email protected] Cert Eff: 09/01/2021 County: Dane Phone:(608) 238-5826 Cert Exp: 08/31/2023 Surveyor: Tina Dary Fax: (608) 238-1221
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 36 of 222 Mental Health Program Directory By County, City, and Provider Name
ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM 2920
406 SCIENCE DRIVE RM #110 & 200 MAEVE O’NEILL Initial Cert: 10/13/2010 MADISON, WI 53711 [email protected] Cert Eff: 09/15/2020 County: Dane Phone:(608) 238-4411 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 238-4412
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 09/15/2020 10/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/15/2020 10/31/2021 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/15/2020 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/15/2020 10/31/2021 MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/15/2020 10/31/2021 NO BRANCH LOCATIONS
SOAR CASE MANAGEMENT 3096
2132 FORDEM AVENUE LALENA LAMPE Initial Cert: 07/02/2015 MADISON, WI 53704 [email protected] Cert Eff: 10/01/2020 County: Dane Phone:(608) 446-9491 Cert Exp: 06/30/2022 Surveyor: Tina Dary Fax: (608) 287-0840
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
ST. MARY'S HOSPITAL MEDICAL CENTER 1872
700 S PARK ST, 6W CHRISTINA MIGNON Initial Cert: 06/01/1983 MADISON, WI 53715 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 258-6707 Cert Exp: 05/31/2022 Surveyor: Tina Dary Fax: (608) 259-5317
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 05/31/2022 NO BRANCH LOCATIONS
THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC 1147
4868 HIGH CROSSING BLVD KEVIN RANDALL Initial Cert: 03/01/1982 MADISON, WI 53704 [email protected] Cert Eff: 07/01/2020 County: Dane Phone:(608) 274-8294 Cert Exp: 03/31/2022 Surveyor: Tina Dary Fax: (608) 274-8783
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2020 03/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 THE CTR CHRISTIAN CNSLNG CONS, 208 E MILWAUKEE AVENUE, FORT ATKINSON, WI 53538 07/01/2020 03/31/2022
09/28/2021 Page 37 of 222 Mental Health Program Directory By County, City, and Provider Name
THE PSYCHOLOGY CLINIC, INC. 1919
310 N MIDVALE BOULEVARD #202 JAMES BLACK, PHD Initial Cert: 10/01/1991 MADISON, WI 53705 [email protected] Cert Eff: 11/01/2020 County: Dane Phone:(608) 238-9991 Cert Exp: 10/31/2022 Surveyor: Tina Dary Fax: (608) 238-1929
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 13, WISCONSIN DELLS, WI 53965 11/01/2020 10/31/2022
2 THE PSYCHOLOGY CLINIC, INC - BARABOO, 137 3RD. AVE, BARABOO, WI 53913 11/01/2020 10/31/2022 2 THE PSYCHOLOGY CLINIC, INC - ODANA, 5555 ODANA RD, STE 202, MADISON, WI 53719 11/01/2020 10/31/2022 2 THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC, 1190 PRAIRIE ST, PRAIRIE DU SAC, WI 53578 11/01/2020 10/31/2022
THE RAINBOW PROJECT, INC. 1920
831 E. WASHINGTON AVENUE SHARYL KATO Initial Cert: 05/01/1988 MADISON, WI 53703 [email protected] Cert Eff: 06/01/2021 County: Dane Phone:(608) 255-7356 Cert Exp: 05/31/2023 Surveyor: Tina Dary Fax: (608) 255-0457
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 REACH DANE, 2096 RED ARROW TR, MADISON, WI 53711 06/01/2021 05/31/2023
TRIQUESTRIAN, LLC 3287
6441 ENTERPRISE LANE #101 TAMI BAHR Initial Cert: 05/22/2020 MADISON, WI 53719 [email protected] Cert Eff: 05/01/2021 County: Dane Phone:(608) 206-4724 Cert Exp: 04/30/2023 Surveyor: Tina Dary Fax: (608) 422-4006
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 TRIQUESTRIAN RISING SPIRITS FARM, 996 STORYTOWN ROAD, BROOKLYN, WI 53521 05/01/2021 04/30/2023
UNIVERSITY OF WI HOSPITALS & CLINICS 1940
122 E. OLIN AVENUE, #275 CYNTHIA GREEN Initial Cert: 11/01/1990 MADISON, WI 53713 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 262-1111 Cert Exp: 04/30/2022 Surveyor: Tina Dary Fax: (608) 263-9045
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 38 of 222 Mental Health Program Directory By County, City, and Provider Name
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY 1953
600 HIGHLAND AVE RACHEL EDWARDS Initial Cert: 01/01/1987 MADISON, WI 53792 [email protected] Cert Eff: 11/01/2019 County: Dane Phone:(608) 263-7528 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
WESTSIDE PSYCHOTHERAPY, LLC 3228
440 SCIENCE DRIVE, SUITE 300 SANDRA EUGSTER Initial Cert: 08/20/2018 MADISON, WI 53705 [email protected] Cert Eff: 12/21/2020 County: Dane Phone:(608) 236-4460 Cert Exp: 07/31/2022 Surveyor: Tina Dary Fax: (608) 236-4461
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/21/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 WESTSIDE PSYCHOTHERAPY, LLC DOWNTOWN, 122 W. WASHINGTON AVE., SUITE 630, MADISON, 12/21/2020 07/31/2022 WI 53703 2 WESTSIDE PSYCHOTHERAPY, LLC EAST, 5315 WALL ST S/290, MADISON, WI 53718 12/21/2020 07/31/2022 2 WESTSIDE PSYCHOTHERAPY, LLC WEST TOWNE, 414 DONOFRIO DR STE 330, MADISON, WI 53719 12/21/2020 07/31/2022
MC FARLAND COMMON THREADS FAMILY RESOURCE CENTER 2779
4800 IVYWOOD TRAIL ELLEN EGGEN Initial Cert: 04/01/2008 MC FARLAND, WI 53558 [email protected] Cert Eff: 10/01/2021 County: Dane Phone:(608) 838-8999 Cert Exp: 09/30/2023 Surveyor: Tina Dary Fax: (608) 838-8988
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS MIDDLETON COMMUNITY CARE PROGRAMS, INC. 1220
6716 STONE GLEN DRIVE DANIEL SIMON Initial Cert: 02/01/1994 MIDDLETON, WI 53562 [email protected] Cert Eff: 04/01/2021 County: Dane Phone:(608) 827-7100 Cert Exp: 03/31/2023 Surveyor: Tina Dary Fax: (608) 827-7101
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ROCK CO DEPT OF HUMAN SVS, 3530 N COUNTY TRK HWY F, JANESVILLE, WI 53547 04/01/2021 03/31/2023 1 JEFFERSON CO DEPT OF HUMAN SVS, 1541 ANNEX ROAD, JEFFERSON, WI 53549 04/01/2021 03/31/2023 1 COLUMBIA CO HHS, 111 E MULLETT ST, PORTAGE, WI 53901 04/01/2021 03/31/2023 1 SAUK CO HUMAN SVS - THERAPY WITHOUT WALLS, 348 E MAIN ST, REEDSBURG, WI 53959 04/01/2021 03/31/2023
3 DOUGLAS ELEMENTARY, 1101 PROSPECT STREET, WATERTOWN, WI 53098 04/01/2021 03/31/2023
09/28/2021 Page 39 of 222 Mental Health Program Directory By County, City, and Provider Name
COMMUNITY COUNSELING CENTER OF MADISON, INC. 1222
6629 UNIVERSITY AVENUE, #209 MARY OLSON Initial Cert: 01/01/1998 MIDDLETON, WI 53562 [email protected] Cert Eff: 02/01/2020 County: Dane Phone:(608) 833-5880 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 829-3787
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
SBH MADISON LLC DBA MIRAMONT BEHAVIORAL HEALTH 3340
3169 DEMING WAY STEVEN CAVENDER Initial Cert: 08/05/2021 MIDDLETON, WI 53562 [email protected] Cert Eff: 08/05/2021 County: Dane Phone:(608) 716-8288 Cert Exp: 07/31/2022 Surveyor: Tina Dary Fax: (901) 969-3120
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 08/05/2021 07/31/2022 NO BRANCH LOCATIONS MONONA SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN 1822
5900 MONONA DRIVE #100 ANGELA LAUFENBERG Initial Cert: 09/01/1994 MONONA, WI 53716 [email protected] Cert Eff: 08/01/2019 County: Dane Phone:(608) 663-0763 Cert Exp: 07/31/2021 Surveyor: Tina Dary Fax: (608) 663-0765
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 WEST MADISON - GOOD SHEPHERD LUTHERAN CHURCH, 5701 RAYMOND RD, MADISON, WI 53711 08/01/2019 07/31/2021
TELLURIAN OUTPATIENT CLINIC 1901
300 FEMRITE DR - 2ND FLOOR KELLY CROOKS Initial Cert: 04/27/2011 MONONA, WI 53716 [email protected] Cert Eff: 08/01/2021 County: Dane Phone:(608) 222-7311 Cert Exp: 07/31/2023 Surveyor: Tina Dary Fax: (608) 222-5904
Services Adm Code Service Begin/End Dates CSAS-INTERVENTION DHS 75.16 08/01/2021 07/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 40 of 222 Mental Health Program Directory By County, City, and Provider Name
OREGON OREGON MENTAL HEALTH SERVICES, LLC 2513
165 W NETHERWOOD ST, STE A MARY SELLA Initial Cert: 05/01/2004 OREGON, WI 53575 [email protected] Cert Eff: 05/01/2021 County: Dane Phone:(608) 835-5050 Cert Exp: 04/30/2023 Surveyor: Tina Dary Fax: (608) 835-5010
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 OREGON MENTAL HEALTH SERVICES LLC, 101 FOUNTAIN ST. STE 2, DODGEVILLE, WI 53533 05/01/2021 04/30/2023
Non-Certified School Setting(s) Setting Begin/End Dates BARNEVELD SCHOOL K-12, 304 S JONES ST, BARNEVELD, WI 53507 05/01/2021 04/30/2023 BELMONT SCHOOL K-12, 646 E LIBERTY ST, BELMONT, WI 53510 05/01/2021 04/30/2023 PECATONICA SCHOOL K-12, 704 CROSS ST, BLANCHARDVILLE, WI 53516 05/01/2021 04/30/2023 BROOKLYN ELEMENTARY SCHOOL, 204 DIVISION ST, BROOKLYN, WI 53521 05/01/2021 04/30/2023 DODGEVILLE HIGH SCHOOL, 912 CHAPEL ST, DODGEVILLE, WI 53533 05/01/2021 04/30/2023 DODGEVILLE MIDDLE SCHOOL, 952 W CHAPEL ST., DODGEVILLE, WI 53533 05/01/2021 04/30/2023 DODGVILLE ELEMENTARY SCHOOL, 404 N JOHNSON ST, DODGEVILLE, WI 53533 05/01/2021 04/30/2023 FOREST EDGE ELEMENTARY, 4848 BRASSICA RD, FITCHBURG, WI 53711 05/01/2021 04/30/2023 NETHERWOOD KNOLL ELEMENTARY, 276 SODEN DRIVE, FITCHBURG, WI 53575 05/01/2021 04/30/2023 HIGHLAND SCHOOL K-12, 1030 CARDINAL DR, HIGHLAND, WI 53543 05/01/2021 04/30/2023 PECATONICA ELEMENTARY, 701 SCHOOL RD, HOLLANDALE, WI 53544 05/01/2021 04/30/2023 LAKE MILLS ELEMENTARY SCHOOL, 155 E PINE ST, LAKE MILLS, WI 53551 05/01/2021 04/30/2023 LAKE MILLS MIDDLE SCHOOL, 318 COLLEGE ST, LAKE MILLS, WI 53551 05/01/2021 04/30/2023 IOWA GRANT SCHOOL K-12, 498 COUNTY RD IG, LIVINGSTON, WI 53554 05/01/2021 04/30/2023 MOUNT HOREB HIGH SCHOOL, 305 S 8TH ST, MOUNT HOREB, WI 53572 05/01/2021 04/30/2023 MOUNT HOREB INTERMEDIATE, 200 HANNENMAN BLVD, MOUNT HOREB, WI 53572 05/01/2021 04/30/2023 MOUNT HOREB MIDDLE SCHOOL, 900 E GARFIELD ST, MOUNT HOREB, WI 53572 05/01/2021 04/30/2023 RIVERDALE ELEMENTARY, 800 N 6TH ST, MUSCODA, WI 53573 05/01/2021 04/30/2023 RIVERDALE MIDDLE SCHOOL, 235 ELM ST., MUSCODA, WI 53573 05/01/2021 04/30/2023 OREGON HIGH SCHOOL, 456 N PERRY PARKWAY, OREGON, WI 53575 05/01/2021 04/30/2023 OREGON MIDDLE SCHOOL, 601 PLEASANT OAK DRIVE, OREGON, WI 53575 05/01/2021 04/30/2023 PRAIRIE VIEW ELEMENTARY SCHOOL, 30 SODEN DRIVE, OREGON, WI 53575 05/01/2021 04/30/2023 ROME CORNERS INTERMEDIATE SCHOOL, 1111 S PERRY PARKWAY, OREGON, WI 53575 05/01/2021 04/30/2023 RIVER VALLEY ELEMENTARY, 830 W. DALEY ST., SPRING GREEN, WI 53588 05/01/2021 04/30/2023 RIVER VALLEY HIGH SCHOOL, 660 VARSITY BLVD, SPRING GREEN, WI 53588 05/01/2021 04/30/2023 RIVER VALLEY MIDDLE SCHOOL, 660 DALEY AVE, SPRING GREEN, WI 53588 05/01/2021 04/30/2023 FOX PRAIRIE ELEMENTARY SCHOOL, 1601 W. SOUTH. ST., STOUGHTON, WI 53589 05/01/2021 04/30/2023 RIVER BLUFF MIDDLE SCHOOL, 235 N FOREST ST., STOUGHTON, WI 53589 05/01/2021 04/30/2023 STOUGHTON HIGH SCHOOL, 600 LINCOLN AVE, STOUGHTON, WI 53589 05/01/2021 04/30/2023 WATERLOO SCHOOL DISTRICT K-12, 813 N. MONROEST., WATERLOO, WI 53594 05/01/2021 04/30/2023
09/28/2021 Page 41 of 222 Mental Health Program Directory By County, City, and Provider Name
STOUGHTON OCEANHAWK COUNSELING ALTERNATIVES, LLC 2675
3185 DEER POINT DR KELLY DAUTE Initial Cert: 07/17/2006 STOUGHTON, WI 53589 [email protected] Cert Eff: 07/01/2019 County: Dane Phone:(608) 873-7838 Cert Exp: 06/30/2021 Surveyor: Tina Dary Fax: (877) 674-2177
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021 NO BRANCH LOCATIONS
STOUGHTON HOSPITAL 1884
900 RIDGE STREET HEATHER KLEINBROOK Initial Cert: 09/01/1997 STOUGHTON, WI 53589 [email protected] Cert Eff: 09/01/2021 County: Dane Phone:(608) 873-2316 Cert Exp: 08/31/2023 Surveyor: Tina Dary Fax: (608) 873-2339
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2021 08/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2021 08/31/2023 NO BRANCH LOCATIONS SUN PRAIRIE HEALING HEARTS FAMILY COUNSELING CENTER, LLC 2916
1268 W MAIN STREET PAT ANN ST. GERMAIN Initial Cert: 09/20/2010 SUN PRAIRIE, WI 53590 [email protected] Cert Eff: 10/01/2021 County: Dane Phone:(608) 834-1122 Cert Exp: 09/30/2023 Surveyor: Tina Dary Fax: (702) 664-6958
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
MERCYLAND PSYCHIATRY INC 3227
425 W MAIN ST, STE 201 ADEBOWALE MOFIKOYA Initial Cert: 11/28/2018 SUN PRAIRIE, WI 53590 [email protected] Cert Eff: 01/27/2021 County: Dane Phone:(608) 318-2233 Cert Exp: 11/30/2021 Surveyor: Tina Dary Fax: (608) 318-2234
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/27/2021 11/30/2021 NO BRANCH LOCATIONS
PRAIRIE COUNSELING SERVICES 1742
1460 W MAIN ST #150 CATHRYN HUBBARD Initial Cert: 07/01/1978 SUN PRAIRIE, WI 53590 [email protected] Cert Eff: 01/01/2021 County: Dane Phone:(608) 837-4814 Cert Exp: 07/31/2022 Surveyor: Tina Dary Fax: (608) 825-4933
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 07/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 42 of 222 Mental Health Program Directory By County, City, and Provider Name
TRIVIUM DBA CROSSROADS COUNSELING CENTER 2868
722-728 LOIS DR TIM PERRY Initial Cert: 08/18/2009 SUN PRAIRIE, WI 53590 [email protected] Cert Eff: 09/01/2021 County: Dane Phone:(608) 837-9112 Cert Exp: 08/31/2023 Surveyor: Tina Dary Fax: (608) 837-9191
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 43 of 222 Mental Health Program Directory By County, City, and Provider Name
DODGE BEAVER DAM AFFILIATED COUNSELING CENTER, LLC 1018
1807 N CENTER ST, #204 SANDRA SCHWEFEL-MASSIE Initial Cert: 11/01/1989 BEAVER DAM, WI 53916 [email protected] Cert Eff: 10/01/2019 County: Dodge Phone:(920) 887-8751 Cert Exp: 09/30/2021 Surveyor: Heather Lom Fax: (920) 887-3977
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
CHURCH HEALTH SERVICES, INC 3106
115 N CENTER STREET MELISSA KEMPFER Initial Cert: 11/17/2015 BEAVER DAM, WI 53916 [email protected] Cert Eff: 11/01/2019 County: Dodge Phone:(920) 887-1766 Cert Exp: 10/31/2021 Surveyor: Heather Lom Fax: (920) 887-2322
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates BEAVER DAM HIGH SCHOOL, 500 GOULD ST, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 BEAVER DAM MIDDLE SCHOOL, 108 FOURTH STREET, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 BEAVER DAM USD ADMIN BLDG, 705 MCKINLEY STREET, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 DON SMITH LEARNING ACADEMY, 400 E BURNETT STREET, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 JEFFERSON ELEMENTARY, 301 BROOK ST, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 LINCOLN ELEMENTARY, 210 GOULD ST, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 PRAIRIE VIEW ELEMTARY, 510 N CRYSTAL LAKE ROAD, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 SO BEAVER DAM ELEMENTARY, W9787 COUNTY ROAD D, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 ST KATHERINE DREXEL SCHOOL, 503 S SPRING ST, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 WASHINGTON ELEMENTARY, 600 GROVE STREET, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 WILSON ELEMENTARY, 405 W 3RD STREET, BEAVER DAM, WI 53916 11/01/2019 10/31/2021 SAGES, 200 S DEPOT ST, FOX LAKE, WI 53933 11/01/2019 10/31/2021 HORICON JR/SR HIGH SCHOOL, 841 GRAY ST, HORICON, WI 53032 11/01/2019 10/31/2021 MEADOW VIEW PRIMARY SCHOOL, 601 GRANDVIEW AVE, WAUPUN, WI 53963 11/01/2019 10/31/2021 ROCK RIVER INTERMEDIATE SCHOOL, 451 E SPRING ST, WAUPUN, WI 53963 11/01/2019 10/31/2021 WAUPUN EDUCATION SERVICE CENTER, 900 WILCOX ST, WAUPUN, WI 53963 11/01/2019 10/31/2021 WAUPUN JR/SR HIGH SCHOOL, 801 LINCOLN ST, WAUPUN, WI 53963 11/01/2019 10/31/2021
09/28/2021 Page 44 of 222 Mental Health Program Directory By County, City, and Provider Name
JUNEAU DODGE COUNTY HUMAN SERVICES & HEALTH DEPT COMPREHENSIVE COMMUNITY SERVICES 2764
199 COUNTY RD DF ALYSSA SCHULTZ Initial Cert: 12/11/2007 JUNEAU, WI 53039 [email protected] Cert Eff: 12/01/2019 County: Dodge Phone:(920) 386-3492 Cert Exp: 11/30/2021 Surveyor: Heather Lom Fax: (920) 386-3812
CCS Affiliaton:LAKESHORE RECOVERY COLLABORATIVE V2 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT 1282
199 COUNTY RD DF ALYSSA SCHULTZ Initial Cert: 10/01/1975 JUNEAU, WI 53039 [email protected] Cert Eff: 03/01/2021 County: Dodge Phone:(920) 386-4094 Cert Exp: 02/28/2023 Surveyor: Heather Lom Fax: (920) 386-3812 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-DAY TREATMENT DHS 75.12 03/01/2021 02/28/2023 CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2021 02/28/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 3 VAN BRUNT ELEMENTARY, 611 MILL ST. RM 447, HORICON, WI 53032 03/01/2021 02/28/2023 3 LOMIRA SCHOOL, 1030 4TH ST., LOMIRA, WI 53048 03/01/2021 02/28/2023 3 MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI 53050 03/01/2021 02/28/2023 3 MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 3013, MAYVILLE, WI 53050 03/01/2021 02/28/2023 3 ROCK RIVER INTERMEDIATE SCHOOL, 451 E. SPRING ST. RM 153 B, WAUPUN, WI 53963 03/01/2021 02/28/2023
DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT CSP 2100
199 COUNTY ROAD DF ALYSSA SCHULTZ Initial Cert: 01/01/1999 JUNEAU, WI 53039 [email protected] Cert Eff: 10/01/2021 County: Dodge Phone:(920) 386-3831 Cert Exp: 09/30/2023 Surveyor: Heather Lom Fax: (920) 386-3812
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 45 of 222 Mental Health Program Directory By County, City, and Provider Name
WATERTOWN WATERTOWN PHYSICIAN PRACTICES, LLC DBA WRMC DIRECTIONS COUNSELING CENTER 1278
123 HOSPITAL DRIVE SUITE 110 GINA NOVOTNY Initial Cert: 11/01/1981 WATERTOWN, WI 53098 [email protected] Cert Eff: 01/01/2020 County: Dodge Phone:(920) 262-4800 Cert Exp: 12/31/2021 Surveyor: Heather Lom Fax: (920) 262-4813
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 WRMC JOHNSON CREEK CLINIC, 540J VILLAGE WALK LANE, JOHNSON CREEK, WI 53038 01/01/2020 12/31/2021 1 WRMC JUNEAU CLINIC, 334 S WESTERN AVENUE, JUNEAU, WI 53039 01/01/2020 12/31/2021 1 WRMC LAKE MILLS CLINIC, 1025 MULBERRY STREET, LAKE MILLS, WI 53551 01/01/2020 12/31/2021 1 WRMC DOCTOR'S COURT CLINIC, 1507 DOCTOR'S COURT, WATERTOWN, WI 53094 01/01/2020 12/31/2021
WAUPUN WAUPUN MEMORIAL HOSPITAL INC DBA OUTPATIENT BEHAVIORAL HEALTH AT WAUPUN 3216
620 W BROWN ST MATTHEW DOLL Initial Cert: 04/13/2018 WAUPUN, WI 53963 [email protected] Cert Eff: 10/01/2020 County: Dodge Phone:(920) 926-4200 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (920) 324-8459
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 46 of 222 Mental Health Program Directory By County, City, and Provider Name
DOOR STURGEON BAY BAY COUNSELING CLINIC 2871
50 SOUTH MADISON AVE SUITE 3 JEANNA GRAHL Initial Cert: 07/01/2009 STURGEON BAY, WI 54235 [email protected] Cert Eff: 07/01/2020 County: Door Phone:(920) 743-4428 Cert Exp: 06/30/2022 Surveyor: Renee DeWitt Fax: (920) 743-4681
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 06/30/2022 NO BRANCH LOCATIONS
COUNSELING ASSOCIATES OF DOOR COUNTY LLC 1250
312 N 5TH AVE JENNI BURLO Initial Cert: 11/16/1993 STURGEON BAY, WI 54235 [email protected] Cert Eff: 12/01/2020 County: Door Phone:(920) 743-9554 Cert Exp: 11/30/2022 Surveyor: Renee DeWitt Fax: (920) 743-1591
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 SOUTHERN DOOR SCHOOLS, 2073 COUNTY RD N, BRUSSELS, WI 54204 12/01/2020 11/30/2022
DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES 1283
421 NEBRASKA STREET DONNA ALTEPETER Initial Cert: 01/01/1978 STURGEON BAY, WI 54235 [email protected] Cert Eff: 10/01/2020 County: Door Phone:(920) 746-7155 Cert Exp: 09/30/2022 Surveyor: Renee DeWitt Fax: (920) 746-2439 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 FAMILY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 09/30/2022
Non-Certified School Setting(s) Setting Begin/End Dates GIBRALTER SCHOOLS, 3924 WISCONSIN 42, FISH CREEK, WI 54212 10/01/2020 09/30/2022
DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES - CCS 3057
421 NEBRASKA STREET CORINNE MCFARLANE Initial Cert: 12/01/2014 STURGEON BAY, WI 54235 [email protected] Cert Eff: 12/01/2019 County: Door Phone:(920) 746-7155 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (920) 746-2439
CCS Affiliaton:LAKESHORE RECOVERY CONSORTIUM Begin: 12/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
09/28/2021 Page 47 of 222 Mental Health Program Directory By County, City, and Provider Name
DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2159
421 NEBRASKA STREET SHERYL FLORES Initial Cert: 10/01/1999 STURGEON BAY, WI 54235 [email protected] Cert Eff: 04/01/2021 County: Door Phone:(920) 746-2340 Cert Exp: 03/31/2023 Surveyor: Renee DeWitt Fax: (920) 746-2439
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
DOOR COUNTY MEMORIAL HOSPITAL DBA DOOR COUNTY MEDICAL CENTER CLINICS 3139
323 S 18TH AVENUE BARB JOHNSON-GIESE Initial Cert: 09/06/2016 STURGEON BAY, WI 54235 [email protected] Cert Eff: 09/01/2021 County: Door Phone:(920) 746-0510 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (920) 746-0099
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 DOOR CO MED CTR CLINIC - ALGOMA, 815 JEFFERSON ST, ALGOMA, WI 54201 09/01/2021 08/31/2023 1 DOOR CO MED CTR CLINIC - FISH CREEK, 3711 HIGHWAY 42, FISH CREEK, WI 54212 09/01/2021 08/31/2023
3 STURGEON BAY HIGH SCHOOL, 1230 MICHIGAN ST, STURGEON BAY, WI 54235 09/01/2021 08/31/2023
LEPAK JOSTSONS INC DBA DYNAMIC FAMILY SOLUTIONS 2869
101 N 4TH AVE JANE A LEPAK JOSTSONS Initial Cert: 08/19/2009 STURGEON BAY, WI 54235 [email protected] Cert Eff: 01/01/2021 County: Door Phone:(920) 323-7431 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (920) 358-5970
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 48 of 222 Mental Health Program Directory By County, City, and Provider Name
DOUGLAS SUPERIOR DOUGLAS CO DEPT HLTH & HUMAN SVS/HUMAN DEVELOPMENT CTR 2964
1500 N 34TH STREET, #100 STEVEN ENGLESON Initial Cert: 07/01/2010 SUPERIOR, WI 54880 [email protected] Cert Eff: 10/01/2020 County: Douglas Phone:(715) 395-6460 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 392-6055
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 2 DHS 34.2 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM 2312
1500 N 34TH ST #100 STEVE ENGLESON Initial Cert: 12/01/1982 SUPERIOR, WI 54880 [email protected] Cert Eff: 10/01/2020 County: Douglas Phone:(715) 392-8216 Cert Exp: 08/31/2022 Surveyor: Rena Andersen Fax: (715) 392-6055
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 08/31/2022 NO BRANCH LOCATIONS
LAKE SUPERIOR COMMUNITY HEALTH CENTER 3195
3600 TOWER AVENUE KRISTIE HILLS Initial Cert: 02/05/2018 SUPERIOR, WI 54880 [email protected] Cert Eff: 02/01/2021 County: Douglas Phone:(218) 722-1497 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (715) 392-1935
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 LSCHC OP MH/AODA OFFICE, 1500 N 34TH STREET #200, SUPERIOR, WI 54880 02/01/2021 01/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates NORTHWESTERN HIGH SCHOOL, 4751 S COUNTY RD F, MAPLE, WI 54854 02/01/2021 01/31/2023 SOLON SPRINGS, 8993 E BALDWIN AVE, SOLON SPRINGS, WI 54873 02/01/2021 01/31/2023 BRYANT ELEMENTARY, 1423 CENTRAL AVE, SUPERIOR, WI 54880 02/01/2021 01/31/2023 COOPER ELEMENTARY, 1807 MISSOURI AVENUE, SUPERIOR, WI 54880 02/01/2021 01/31/2023 FOUR CORNERS ELEMENTARY, 4465 E. COUNTY RD B, SUPERIOR, WI 54880 02/01/2021 01/31/2023 GREAT LAKES ELEMENTARY, 129 N. 28TH STREET E, SUPERIOR, WI 54880 02/01/2021 01/31/2023 LAKE SUPERIOR ELEMENTARY, 3200 E 3RD ST, SUPERIOR, WI 54880 02/01/2021 01/31/2023 NORTHERN LIGHTS ELEMENTARY, 1201 N. 28TH STREET, SUPERIOR, WI 54880 02/01/2021 01/31/2023 SUPERIOR HIGH SCHOOL, 2600 CATLIN AVE, SUPERIOR, WI 54880 02/01/2021 01/31/2023 SUPERIOR MIDDLE SCHOOL, 3626 HAMMOND AVE, SUPERIOR, WI 54880 02/01/2021 01/31/2023
09/28/2021 Page 49 of 222 Mental Health Program Directory By County, City, and Provider Name
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - SUPERIOR 3105
69 N 28TH ST E STE 28 JACKIE MAURER Initial Cert: 01/11/2016 SUPERIOR, WI 54880 [email protected] Cert Eff: 01/01/2021 County: Douglas Phone:(715) 394-2867 Cert Exp: 12/31/2022 Surveyor: Rena Andersen Fax: (715) 394-2869
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
SMHS PARTIAL HOSPITALIZATION PROGRAM 3238
3500 TOWER AVE JULIANNE DAVIS Initial Cert: 03/22/2019 SUPERIOR, WI 54880 [email protected] Cert Eff: 03/01/2020 County: Douglas Phone:(218) 786-8645 Cert Exp: 02/28/2022 Surveyor: Rena Andersen Fax: (218) 722-0373
Services Adm Code Service Begin/End Dates MENTAL HEALTH-DAY TREATMENT DHS 61.75 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
THE CREATIVE COUNSELING GROUP, LLC 3111
3215 TOWER AVENUE, STE 108 DONALD MATTSON Initial Cert: 11/11/2015 SUPERIOR, WI 54880 [email protected] Cert Eff: 11/01/2019 County: Douglas Phone:(715) 718-5606 Cert Exp: 10/31/2021 Surveyor: Rena Andersen Fax: (715) 718-5607
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 50 of 222 Mental Health Program Directory By County, City, and Provider Name
DUNN MENOMONIE ARBOR PLACE, INC. 1050
4076 KOTHLOW AVE JILL GAMEZ Initial Cert: 12/01/1993 MENOMONIE, WI 54751 [email protected] Cert Eff: 10/01/2021 County: Dunn Phone:(715) 235-4537 Cert Exp: 09/30/2023 Surveyor: Roderick Senn Fax: (715) 235-4535
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2021 09/30/2023 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 10/01/2021 09/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2021 09/30/2023 CSAS-PREVENTION DHS 75.04 10/01/2021 09/30/2023 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 10/01/2021 09/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 ARBOR PLACE, INC - RIVER FALLS, 103 S SECOND ST, RIVER FALLS, WI 54022 10/01/2021 09/30/2023
DUNN COUNTY DEPARTMENT OF HUMAN SERVICES BEHAVIORAL HEALTH SERVICES 1287
3001 US HWY 12 EAST SUITE 160 WENDY WINGER Initial Cert: 01/01/1981 MENOMONIE, WI 54751 [email protected] Cert Eff: 09/01/2020 County: Dunn Phone:(715) 231-2706 Cert Exp: 05/31/2022 Surveyor: Roderick Senn Fax: (715) 232-5987 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 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2020 05/31/2022 NO BRANCH LOCATIONS
DUNN COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2055
3001 US HWY 12 EAST, SUITE 160 WENDY WINGER Initial Cert: 06/01/1998 MENOMONIE, WI 54751 [email protected] Cert Eff: 06/01/2021 County: Dunn Phone:(715) 232-1116 Cert Exp: 05/31/2023 Surveyor: Roderick Senn Fax: (715) 232-5987
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
MAYO CLINIC HEALTH SYSTEM RED CEDAR 1780
2411 STOUT ROAD EVE FISCHER Initial Cert: 11/01/1992 MENOMONIE, WI 54751 [email protected] Cert Eff: 04/30/2021 County: Dunn Phone:(715) 838-5248 Cert Exp: 10/31/2022 Surveyor: Roderick Senn Fax: (715) 838-3032
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/30/2021 10/31/2022 NO BRANCH LOCATIONS
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NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - MENOMONIE 2660
402 TECHNOLOGY DR E JACKIE MAURER Initial Cert: 03/01/2006 MENOMONIE, WI 54751 [email protected] Cert Eff: 03/01/2021 County: Dunn Phone:(715) 235-4245 Cert Exp: 02/28/2023 Surveyor: Roderick Senn Fax: (888) 293-7837
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
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EAU CLAIRE ALTOONA AUTISM AND BEHAVIOR CENTER, INC 2733
919 S HILLCREST PKWY KRISTIN WEGNER Initial Cert: 05/29/2007 ALTOONA, WI 54720 [email protected] Cert Eff: 09/01/2020 County: Eau Claire Phone:(715) 598-7121 Cert Exp: 05/31/2022 Surveyor: Roderick Senn Fax: (715) 598-7123
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022 NO BRANCH LOCATIONS EAU CLAIRE CAILLIER CLINIC, LTD. 1119
2620 STEIN BLVD STE B TODD CAILLIER Initial Cert: 01/01/1983 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 12/01/2020 County: Eau Claire Phone:(715) 836-0064 Cert Exp: 11/20/2022 Surveyor: Roderick Senn Fax: (715) 836-0065
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/20/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/20/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CAILLIER CLINIC LTD, 1729 WESTGATE RD, EAU CLAIRE, WI 54703 12/01/2020 11/20/2022 2 CALLIER CLINIC LTD, 700 WOLSKE BAY RD, STE 210, MENOMONIE, WI 54751 12/01/2020 11/20/2022 2 CAILLIER CLINIC, LTD, 138 N. MAIN ST SUITE 206, RICE LAKE, WI 54868 12/01/2020 11/20/2022
Non-Certified School Setting(s) Setting Begin/End Dates ALTOONA MIDDLE AND HIGH SCHOOL, 1903 BARTLETT AVE, ALTOONA, WI 54720 12/01/2020 11/20/2022 CHIPPEWA FALLLS HIGH SCHOOL, 1130 MILES STREET, CHIPPEWA FALLS, WI 54729 12/01/2020 11/20/2022 COLFAX MIDDLE SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730 12/01/2020 11/20/2022
CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1186
2004 HIGHLAND AVE SUITE M VERA MATTER Initial Cert: 09/01/1983 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 01/01/2020 County: Eau Claire Phone:(715) 835-5915 Cert Exp: 12/31/2021 Surveyor: Roderick Senn Fax: (715) 835-8112
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 BLACK RIVER FALLS HEAD START CENTER, 905 ALDER ST, BLACK RIVER FALLS, WI 54615 01/01/2020 12/31/2021
2 CHILDREN'S WISCONSIN - BLACK RIVER FALLS, W1109 ROGERS RD, BLACK RIVER FALLS, WI 54615 04/20/2021 12/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates ALTOONA HIGH SCHOOL, 711 7TH STREET WEST, ALTOONA, WI 54720 01/01/2020 12/31/2021 ALTOONA MIDDLE SCHOOL, 1903 BARTLETT AVE, ALTOONA, WI 54720 01/01/2020 12/31/2021 LOCUST LANE ELEMENTARY, 3245 LOCUST LANE, EAU CLAIRE, WI 54703 01/01/2020 12/31/2021 MANZ ELEMENTARY, 1000 EAST FILLMORE AVE, EAU CLAIRE, WI 54701 01/01/2020 12/31/2021 ROOSEVELT ELEMENTARY SCHOOL, 3010 8TH STREET, EAU CLAIRE, WI 54703 01/01/2020 12/31/2021 SAM DAVEY ELEMENTARY, 3000 STARR AVE, EAU CLAIRE, WI 54703 01/01/2020 12/31/2021
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CLINIC FOR CHRISTIAN COUNSELING, LLC 3240
3410 OAKWOOD MALL DR, STE 700 KIMBERLY STEIN Initial Cert: 05/01/2018 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 01/01/2020 County: Eau Claire Phone:(715) 832-1678 Cert Exp: 12/31/2021 Surveyor: Roderick Senn Fax: (715) 832-6680
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 CLINIC FOR CHRISTIAN COUNSELING, LLC, 12 W MARSHALL ST, STE 201, RICE LAKE, WI 54868 01/01/2020 12/31/2021
3 CRESTVIEW ACADEMY, 1519 PETERSON AVE, EAU CLAIRE, WI 54703 01/01/2020 12/31/2021
EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES 2815
721 OXFORD AVENUE LUKE FEDIE Initial Cert: 09/09/2008 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 09/01/2021 County: Eau Claire Phone:(715) 839-7576 Cert Exp: 08/31/2023 Surveyor: Roderick Senn Fax: (715) 831-5784 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 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES - CCS PROGRAM 3112
721 OXFORD AVENUE CINTHIA WIEBUSCH Initial Cert: 04/01/2016 EAU CLAIRE, WI 54703 [email protected] Cert Eff: 04/01/2021 County: Eau Claire Phone:(715) 495-4083 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (715) 831-5783
CCS Affiliaton:BEST CCS Begin: 01/01/2019
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES CSP 1293
721 OXFORD AVENUE DIANE CABLE Initial Cert: 01/01/1990 EAU CLAIRE, WI 54703 [email protected] Cert Eff: 03/01/2020 County: Eau Claire Phone:(715) 839-6500 Cert Exp: 02/28/2022 Surveyor: Roderick Senn Fax: (715) 831-5783
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
09/28/2021 Page 54 of 222 Mental Health Program Directory By County, City, and Provider Name
ENIGMA PSYCHOLOGICAL INC 3178
4330 GOLF TERRACE #209 RUSSELL GIRARD Initial Cert: 09/01/2017 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 01/01/2021 County: Eau Claire Phone:(715) 491-7370 Cert Exp: 08/31/2022 Surveyor: Roderick Senn Fax: (715) 598-6222
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022 NO BRANCH LOCATIONS
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LUTHERAN SOCIAL SERVICES OF WISCONSIN & UPPER MICHIGAN INC OUTPATIENT COUNSELING 2797
120 S BARSTOW STREET BRITTANY NESSEL Initial Cert: 07/30/2008 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 07/01/2021 County: Eau Claire Phone:(715) 832-2221 Cert Exp: 06/30/2023 Surveyor: Roderick Senn Fax: (715) 838-8423
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 LSS OF WI & UPPER MI OUTPATIENT COUNSELING - CARR, 201 W CENTRAL ST, CHIPPEWA FALLS, 09/27/2021 06/30/2023 WI 54729 2 LSS OF WI & UPPER MI OUTPATIENT, 306 S BARSTOW, EAU CLAIRE, WI 54701 07/01/2021 06/30/2023
Non-Certified School Setting(s) Setting Begin/End Dates ABBOTSFORD ELEMENTARY SCHOOL, 510 W. HEMLOCK ST, ABBOTSFORD, WI 54405 07/01/2021 06/30/2023 ABBOTSFORD MIDDLE AND HIGH SCHOOL, 307 N 4TH AVE, ABBOTSFORD, WI 54405 07/01/2021 06/30/2023 ALTOONA ELEMENTARY SCHOOL, 157 BARTLETT AVE, ALTOONA, WI 54720 07/01/2021 06/30/2023 ALTOONA HIGH SCHOOL, 711 7TH ST W, ALTOONA, WI 54720 07/01/2021 06/30/2023 ALTOONA MIDDLE SCHOOL, 1903 BARTLETT AVE, ALTOONA, WI 54720 07/01/2021 06/30/2023 BARRON HIGH SCHOOL, 1050 EAST WOODLAND AVE, BARRON, WI 54812 07/01/2021 06/30/2023 RIVERVIEW MIDDLE SCHOOL, 135 WEST RIVER AVE, BARRON, WI 54812 07/01/2021 06/30/2023 WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVE, BARRON, WI 54812 07/01/2021 06/30/2023 BLOOMER ELEMENTARY, 401 8TH STREET, BLOOMER, WI 54724 07/01/2021 06/30/2023 BLOOMER HIGH SCHOOL, 1310 17TH AVE, BLOOMER, WI 54724 07/01/2021 06/30/2023 BLOOMER MIDDLE SCHOOL, 600 JACKSON ST, BLOOMER, WI 54724 07/01/2021 06/30/2023 CADOTT ELEMENTARY SCHOOL, 463 E MILLS ST, CADOTT, WI 54727 07/01/2021 06/30/2023 CADOTT JUNIOR/SENIOR HIGH SCHOOL, 426 MYRTLE ST, CADOTT, WI 54727 07/01/2021 06/30/2023 CAMERON ELEMENTARY SCHOOL, 919 NORTH 2ND ST, CAMERON, WI 54822 07/01/2021 06/30/2023 CAMERON HIGH SCHOOL, 750 1ST ST, CAMERON, WI 54822 07/01/2021 06/30/2023 CAMERON MIDDLE SCHOOL, 700 SOUTH 1ST ST, CAMERON, WI 54822 07/01/2021 06/30/2023 CHETEK-WEYERHAUSER MIDDLE AND HIGH SCHOOL, 1001 KNAPP ST, CHETEK, WI 54728 07/01/2021 06/30/2023 ROSELAWN ELEMENTARY SCHOOL, 1201 6TH ST, CHETEK, WI 54728 07/01/2021 06/30/2023 CHIPPEWA FALLS HIGH SCHOOL, 735 TERRILL ST, CHIPPEWA FALLS, WI 54729 07/01/2021 06/30/2023 CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA BLVD, CHIPPEWA FALLS, WI 54729 07/01/2021 06/30/2023 HOLY GHOST ELEMENTARY SCHOOL, 436 MAIN ST, CHIPPEWA FALLS, WI 54729 07/01/2021 06/30/2023 NOTRE DAME MIDDLE SCHOOL/MCDONNELL HIGH SCHOOL, 1316 BEL AIR BLVD, CHIPPEWA FALLS, 07/01/2021 06/30/2023 WI 54729 CORNELL ELEMENTARY, 111 SOUTH 4TH STREET, CORNELL, WI 54732 07/01/2021 06/30/2023 CORNELL MIDDLE/HIGH SCHOOL, 708 BRIDGE STREET, CORNELL, WI 54732 07/01/2021 06/30/2023 CADDY WOODLAWN ELEMENTARY SCHOOL, 650 AUTH ST, DURAND, WI 54736 07/01/2021 06/30/2023 DURAND-ARKANSAW MIDDLE/HIGH SCHOOL, 604 7TH AVE, DURAND, WI 54736 07/01/2021 06/30/2023 DELONG MIDDLE SCHOOL, 2000 VINE ST, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 LONGFELLOW ELEMENTARY SCHOOL, 500 BALCOM ST, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 MANZ ELEMENTARY SCHOOL, E FILLMORE AVE, EAU CLAIRE, WI 54701 07/01/2021 06/30/2023 MEMORIAL HIGH SCHOOL, 2225 KEITH ST, EAU CLAIRE, WI 54701 07/01/2021 06/30/2023 NORTH HIGH SCHOOL, 1801 PIEDMONT AVENUE, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 NORTHSTAR MIDDLE SCHOOL, 2711 ABBE HILL DR, EAU CLAIRE, WI 54701 07/01/2021 06/30/2023 NORTHWOODS ELEMENTARY SCHOOL, 3600 NORTHWOODS LN, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 PUTNAM ELEMENTARY SCHOOL, 633 W MACARTHUR AVE, EAU CLAIRE, WI 54701 07/01/2021 06/30/2023 SAM DAVEY ELEMENTARY SCHOOL, 3000 STARR AVE, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 SHERMAN ELEMENTARY SCHOOL, 3110 W VINE ST, EAU CLAIRE, WI 54703 07/01/2021 06/30/2023 GILMAN ELEMENTARY AND HIGH SCHOOL, 325 N. 5TH AVE., GILMAN, WI 54433 07/01/2021 06/30/2023 09/28/2021 Page 56 of 222 Mental Health Program Directory By County, City, and Provider Name
GRANTON ELEMENTARY, MIDDLE, AND HIGH SCHOOL, 217 N MAIN ST, GRANTON, WI 54436 07/01/2021 06/30/2023 GRANTSBURG MIDDLE SCHOOL, 500 E JAMES AVE, GRANTSBURG, WI 54840 07/01/2021 06/30/2023 HAUGEN ELEMENTARY, MIDDLE AND HIGH SCHOOL, 615 WEST 5TH ST, HAUGEN, WI 54841 07/01/2021 06/30/2023 LADYSMITH ELEMENTARY SCHOOL, 115 E 6TH ST S, LADYSMITH, WI 54848 07/01/2021 06/30/2023 LADYSMITH MIDDLE AND HIGH SCHOOL, 1700 EDGEWOOD AVE E, LADYSMITH, WI 54848 07/01/2021 06/30/2023 RIVER HEIGHTS ELEMENTARY SCHOOL, 615 24TH AVE W, MENOMONIE, WI 54751 07/01/2021 06/30/2023 NEILLSVILLE ELEMENTARY SCHOOL, 614 EAST 5TH ST, NEILLSVILLE, WI 54456 07/01/2021 06/30/2023 NEILLSVILLE MIDDLE AND HIGH SCHOOL, 401 CENTER ST, NEILLSVILLE, WI 54456 07/01/2021 06/30/2023 NEW AUBURN ELEMENTARY, MIDDLE, AND HIGH SCHOOL, 704 N EAST ST, NEW AUBURN, WI 54757 07/01/2021 06/30/2023 OSSEO-FAIRCHILD ELEMENTARY SCHOOL, 513025 15TH ST, OSSEO, WI 54758 07/01/2021 06/30/2023 OSSEO-FAIRCHILD MIDDLE AND HIGH SCHOOL, 5085 EAST ST, OSSEO, WI 54758 07/01/2021 06/30/2023 HILLTOP ELEMENTARY SHOOL, 202 CAMERON RD, RICE LAKE, WI 54868 07/01/2021 06/30/2023 RICE LAKE HIGH SCHOOL, 305 WISCONSIN AVENUE, RICE LAKE, WI 54868 07/01/2021 06/30/2023 RICE LAKE MIDDLE SCHOOL, 204 CAMERON RD, RICE LAKE, WI 54868 07/01/2021 06/30/2023 TAINTER ELEMENTARY SCHOOL, 2201 CARRIE AVENUE, RICE LAKE, WI 54868 07/01/2021 06/30/2023 RIDGELAND/DALLAS SCHOOLS, 315 MAIN STREET, RIDGELAND, WI 54763 07/01/2021 06/30/2023 SHELL LAKE ELEMENTARY, 31 3RD ST, SHELL LAKE, WI 54871 07/01/2021 06/30/2023 SHELL LAKE MIDDLE AND HIGH SCHOOL, 271 HWY 63, SHELL LAKE, WI 54871 07/01/2021 06/30/2023 STANLEY-BOYD ELEMENTARY, MIDDLE AND HIGH SCHOOL, 507 EAST 1ST AVENUE, STANLEY, WI 07/01/2021 06/30/2023 54768 THORP ELEMENTARY, MIDDLE AND HIGH SCHOOL, 605 SOUTH CLARK STREET, THORP, WI 54771 07/01/2021 06/30/2023
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MARRIAGE AND FAMILY HEALTH SERVICES 1562
2925 MONDOVI ROAD VICTOR MICHALEK Initial Cert: 09/01/1983 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 05/01/2021 County: Eau Claire Phone:(715) 832-0238 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (715) 832-0771
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 05/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 MARRIAGE AND FAMILY HEALTH SERVICES, 132 W COLUMBIA ST, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 2 MARRIAGE & FAMILY HEALTH SERVICES, 2910 ENLOE ST, HUDSON, WI 54016 05/01/2021 04/30/2022 2 MARRIAGE & FAMILY HEALTH SERVICES, 105 WEST AVENUE, RICE LAKE, WI 54868 05/01/2021 04/30/2022
3 MFHS-AUGUSTA ELEMENTARY, E19320 BARTIG RD, AUGUSTA, WI 54722 05/01/2021 04/30/2022 3 MFHS-AUGUSTA HIGH SCHOOL, E19320 BARTIG RD, AUGUSTA, WI 54722 05/01/2021 04/30/2022 3 MFHS-AUGUSTA MIDDLE SCHOOL, E19320 BARTIG RD, AUGUSTA, WI 54722 05/01/2021 04/30/2022 3 MFHS-BARRON HIGH SCHOOL, 1050 E WOODLAND AVE, BARRON, WI 54812 05/01/2021 04/30/2022 3 MFHS-RIVERVIEW MIDDLE SCHOOL, 135 WEST RIVER AVE, BARRON, WI 54812 05/01/2021 04/30/2022 3 MFHS-WOODLAND ELEMENTARY, 808 E WOODLAND AVE, BARRON, WI 54812 05/01/2021 04/30/2022 3 MFHS-BLOOMER HIGH SCHOOL, 1310 17TH AVENUE, BLOOMER, WI 54724 05/01/2021 04/30/2022 3 MFHS-BLOOMER MIDDLE SCHOOL, 600 JACKSON ST, BLOOMER, WI 54724 05/01/2021 04/30/2022 3 MFHS-CAMERON HIGH SCHOOL, 750 SOUTH 1ST STREET, CAMERON, WI 54822 05/01/2021 04/30/2022 3 MFHS-CAMERON MIDDLE SCHOOL, 700 SOUTH 1ST STREET, CAMERON, WI 54822 05/01/2021 04/30/2022 3 MFHS- HALMSTAD ELEMENTARY, 565 E SOUTH AVE, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-CHIPPEWA FALLS HIGH SCHOOL, 735 TERRILL STREET, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-CHIPPEWA VALLEY HIGH SCHOOL, 2820 E PARK AVENUE, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-HILCREST ELEMENTARY, 1200 MILES STREET, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-PARKVIEW ELEMENTARY, 501 JEFFERSON AVENUE, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-SOUTHVIEW ELEMENTARY, 615 A STREET, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-STILLSON ELEMENTARY, 17250 HWY J, CHIPPEWA FALLS, WI 54729 05/01/2021 04/30/2022 3 MFHS-CUMBERLAND ELEMENTARY, 1530 2ND AVE, CUMBERLAND, WI 54829 05/01/2021 04/30/2022 3 MFHS-CUMBERLAND HIGH SCHOOL, 1000 8TH AVENUE, CUMBERLAND, WI 54829 05/01/2021 04/30/2022 3 MFHS-CUMBERLAND MIDDLE SCHOOL, 980 8TH AVENUE, CUMBERLAND, WI 54829 05/01/2021 04/30/2022 3 MFHS-CADDIE WOODLAND ELEMENTARY, 650 AUTH ST, DURAND, WI 54736 05/01/2021 04/30/2022 3 MFHS-DURAND MIDDLE & HIGH SCHOOL, 604 - 7TH AVE. EAST, PO BOX 190, DURAND, WI 54736 05/01/2021 04/30/2022 3 MFHS- DELONG MIDDLE SCHOOL, 2000 VINE ST, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- FLYNN ELEMENTARY, 1430 LEE ST, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- LAKESHORE ELEMENTARY, 711 LAKE STREET, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- LONGFELLOW ELEMENTARY, 500 BALCOM ST, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- MEMORIAL HIGH SCHOOL, 2225 KEITH ST, EAU CLAIRE, WI 54701 05/01/2021 04/30/2022 3 MFHS- NORHTSTAR MIDDLE SCHOOL, 2711 ABBE HILL DR, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- NORTH HIGH SCHOOL, 1801 PIEDMONT RD, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS- NORTHWOODS ELEMENTARY, 3600 NORTHWOODS, EAU CLAIRE, WI 54701 05/01/2021 04/30/2022 3 MFHS- PUTNAM HEIGHTS ELEMENTARY, 633 W MACARTHUR AVE, EAU CLAIRE, WI 54701 05/01/2021 04/30/2022 3 MFHS- SOUTH MIDDLE SCHOOL, 2115 MITSCHER AVE, EAU CLAIRE, WI 54701 05/01/2021 04/30/2022 3 MFHS-CHIPPEWA VALLEY MONTESSORI, 400 CAMERON ST, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS-SHERMAN ELEMENTARY, 3110 VINE STREET, EAU CLAIRE, WI 54703 05/01/2021 04/30/2022 3 MFHS-ELK MOUND HIGH SCHOOL, 405 UNIVERSITY ST., ELK MOUND, WI 54739 05/01/2021 04/30/2022 3 MFHS-ELK MOUND MIDDLE SCHOOL, 302 UNIVERSITY ST., ELK MOUND, WI 54739 05/01/2021 04/30/2022 3 MFHS-MOUND VIEW ELEMENTARY, 455 UNIVERSITY ST, ELK MOUND, WI 54739 05/01/2021 04/30/2022
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3 MFHS-ELLSWORTH ELEMENTARY, 445 SO PIETY ST, ELLSWORTH, WI 54011 05/01/2021 04/30/2022 3 MFHS-ELLSWORTH HIGH SCHOOL, 323 HILLCREST STREET, ELLSWORTH, WI 54011 05/01/2021 04/30/2022 3 MFHS-ELLSWORTH MIDDLE SCHOOL, 312 WEST PANTHER DRIVE, ELLSWORTH, WI 54011 05/01/2021 04/30/2022 3 FALL CREEK ELEM, MIDDLE & HIGH SCHOOL, 336 E. HOOVER AVE., FALL CREEK, WI 54742 05/01/2021 04/30/2022 3 MFHS-JIM FALLS ELEMENTARY, 13643 - 198TH STREET, JIM FALLS, WI 54748 05/01/2021 04/30/2022 3 MFHS- OAK LAWN ELEMENTARY, 500 21ST ST SOUTH, MENOMONIE, WI 54751 05/01/2021 04/30/2022 3 MFHS-MENOMONIE HIGH SCHOOL, 1714 5TH ST WEST, MENOMONIE, WI 54751 05/01/2021 04/30/2022 3 MFHS-MENOMONIE MIDDLE SCHOOL, 920 21ST STREET SE, MENOMONIE, WI 54751 05/01/2021 04/30/2022 3 MFHS-RIVERS HEIGHTS ELEMENTARY, 215 24TH AVE WEST, MENOMONIE, WI 54751 05/01/2021 04/30/2022 3 MFHS-WAKANDA ELEMENTARY, 1801 WAKANDA ST NE, MENOMONIE, WI 54751 05/01/2021 04/30/2022 3 MFHS-GREENWOOD ELEMENTARY, 982 E DIVISION ST, RIVER FALLS, WI 54022 05/01/2021 04/30/2022 3 MFHS-MEYER MIDDLE SCHOOL, 230 N. 9TH ST., RIVER FALLS, WI 54022 05/01/2021 04/30/2022 3 MFHS-RIVER FALLS HIGH SCHOOL, 818 CEMETERY RD., RIVER FALLS, WI 54022 05/01/2021 04/30/2022 3 MFHS-RIVER FALLS MONTESSORI, 2815 PRAIRIE DR, RIVER FALLS, WI 54022 05/01/2021 04/30/2022 3 MFHS-ROCKY BRANCH ELEMENTARY, 1415 S BARTOSH LANE, RIVER FALLS, WI 54022 05/01/2021 04/30/2022 3 MFHS-WESTSIDE ELEMENTARY, 1007 W PINE ST, RIVER FALLS, WI 54022 05/01/2021 04/30/2022
MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC 1511
1221 WHIPPLE STREET CORY CARLSON Initial Cert: 06/01/1981 EAU CLAIRE, WI 54703 [email protected] Cert Eff: 12/01/2020 County: Eau Claire Phone:(715) 838-6752 Cert Exp: 11/30/2022 Surveyor: Roderick Senn Fax: (715) 838-3649
Services Adm Code Service Begin/End Dates MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2020 11/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
MAYO CLINIC HEALTH SYSTEM EAU CLAIRE 1512
1221 WHIPPLE STREET EVE FISCHER Initial Cert: 10/01/1981 EAU CLAIRE, WI 54703 Cert Eff: 01/01/2021 County: Eau Claire Phone:(715) 838-5369 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (715) 838-3032
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 MAYO CLINIC HEALTH SYSTEMS - CHIPPEWA FALLS OFFICE, 611 1ST AVENUE, CHIPPEWA FALLS, 01/01/2021 12/31/2022 WI 54729 2 MAYO CLINIC HEALTH SYSTEM NORTHLAND, 331 S MAIN STREET, RICE LAKE, WI 54868 01/01/2021 12/31/2022
MOSAIC COUNSELING GROUP LLC 3147
3430 OAKWOOD MALL DRIVE STE 200 JODI BRIGHT Initial Cert: 09/16/2016 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 10/01/2021 County: Eau Claire Phone:(715) 514-0455 Cert Exp: 09/30/2023 Surveyor: Roderick Senn Fax: (715) 514-0272
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 59 of 222 Mental Health Program Directory By County, City, and Provider Name
SACRED HEART BEHAVIORAL HEALTH CLINIC DBA PREVEA HEALTH 2947
2119 HEIGHTS DRIVE NICOLE CALIFF Initial Cert: 10/31/2011 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 10/01/2020 County: Eau Claire Phone:(715) 717-5899 Cert Exp: 09/30/2022 Surveyor: Roderick Senn Fax: (715) 717-5898
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2020 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 PREVEA CANCER CTR AT HSHS SACRED HEART HOSP, 900 W CLAIREMONT AVE, EAU CLAIRE, WI 10/01/2020 09/30/2022 54701 1 PREVEA HEALTH FAMILY MEDICINE, 617 W CLAIREMONT AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022
2 PREVEA ALTOONA MEDICAL OFFICE BLDG, 3119 WOODMAN DR, ALTOONA, WI 54720 10/01/2020 09/30/2022 2 CHIPPEWA FALLS CLINIC, 2449 COUNTY HWY I, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 2 PREVEA LADYSMITH HEALTH CENTER, 1101 W LAKE AVE, LADYSMITH, WI 54848 10/01/2020 09/30/2022 2 PREVEA MENOMONIE HEATH CENTER, 2919 STOUT ROAD, MENOMONIE, WI 54751 10/01/2020 09/30/2022 2 RICE LAKE CLINIC, 1051 WEST AVENUE, RICE LAKE, WI 54868 10/01/2020 09/30/2022
3 LAKE HOLCOMBE ELEM/HIGH SCHOOL, 27331 262ND AVE, HOLCOMBE, WI 54745 10/01/2020 09/30/2022
Non-Certified School Setting(s) Setting Begin/End Dates CHIPPEWA FALLS HIGH, 735 TERRIL ST, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 CHIPPEWA FALLS MIDDLE, 750 TROPICANA BLVD, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 CHIPPEWA VALLEY HIGH, 2820 E PARK AVE, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 HALMSTAD ELEMENTARY, 565 E SOUTH AVE, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 HILLCREST ELEMENTARY, 1200 MILES ST, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 PARKVIEW ELEMENTARY, 501 JEFFERSON AVE, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 SOUTHVIEW ELEMENTARY, 615 A STREET, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 STILLSON, 17250 CTY HWY J, CHIPPEWA FALLS, WI 54729 10/01/2020 09/30/2022 CHIPPEWA VALLEY MONTESSORI, 400 CAMERON ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 DELONG MIDDLE, 2000 VINE ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 ECASD EARLY LEARNING PROGRAM, 3031 EPIPHANY LANE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 FLYNN ELEMENTARY, 1430 LEE ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 LAKESHORE ELEMENTARY, 711 LAKE ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 LOCUST LANE ELEMENTARY, 3245 LOCUST LANE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 LONGFELLOW ELEMENTARY, 500 BALCOM, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 MANZ ELEMENTARY, 1000 E FILMORE AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 MCKINLEY CHARTER, 1266 MCKINLEY RD, EAU CLAIRE, WI 54703 10/01/2020 09/30/2022 MEADOWVIEW ELEMENTARY, 4714 FAIRFAX, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 MEMORIAL HIGH, 2225 KEITH ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 NORTH HIGH, 1801 PIEDMONT RD, EAU CLAIRE, WI 54703 10/01/2020 09/30/2022 NORTHSTAR MIDDLE, 2711 ABBE HILL DR, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 NORTHWOODS ELEMENTARY, 3600 NORTHWOODS LANE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 PUTNAM HEIGHTS ELEMENTARY, 633 W MACARTHUR AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 ROBBINS ELEMENTARY, 3832 E HAMILTON AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 ROOSEVELT ELEMENTARY, 3010 8TH ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 SAM DAVEY ELEMENTARY, 3000 STARR AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 SHERMAN ELEMENTARY, 3110 W VINE ST, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 SOUTH MIDDLE, 2115 MITSCHER AVE, EAU CLAIRE, WI 54701 10/01/2020 09/30/2022 JIM FALLS ELEMENTARY, 13643 198TH ST, JIM FALLS, WI 54748 10/01/2020 09/30/2022
09/28/2021 Page 60 of 222 Mental Health Program Directory By County, City, and Provider Name
SACRED HEART HOSPITAL 2029
900 W. CLAIREMONT AVENUE TONI SIMONSON Initial Cert: 02/01/1982 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 01/01/2021 County: Eau Claire Phone:(715) 717-4272 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (715) 717-4996
Services Adm Code Service Begin/End Dates MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 01/01/2021 12/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER 1408
2005 HIGHLAND AVE MARY SOKUP Initial Cert: 08/01/1990 EAU CLAIRE, WI 54701 [email protected] Cert Eff: 01/01/2021 County: Eau Claire Phone:(715) 834-3171 Cert Exp: 08/31/2022 Surveyor: Roderick Senn Fax: (715) 832-2991
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 1443 B EAST DIVISION AVE, BARRON, 01/01/2021 08/31/2022 WI 54812
09/28/2021 Page 61 of 222 Mental Health Program Directory By County, City, and Provider Name
FOND DU LAC FOND DU LAC AGNESIAN HEALTHCARE DBA DOLL AND ASSOCIATES 2226
40 CAMELOT DRIVE BETH ROGERS-DOLL Initial Cert: 07/05/2000 FOND DU LAC, WI 54935 [email protected] Cert Eff: 07/01/2021 County: Fond Du Lac Phone:(920) 907-3961 Cert Exp: 06/30/2023 Surveyor: Heather Lom Fax: (920) 907-8209
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 1 INTEGRATIVE HLTH PLAZA LEVEL A, 421 CAMELOT DR, FOND DU LAC, WI 54935 07/01/2021 06/30/2023
2 TREFFERT CENTER, 371 E 1ST STREET, FOND DU LAC, WI 54935 07/01/2021 06/30/2023
3 BESSIE ALLEN MIDDLE SCHOOL, 305 MCKINLEY ST, FOND DU LAC, WI 54937 07/01/2021 06/30/2023 3 FRIENDSHIP LEARNING CENTER, 1098 PROSPECT AVE, FOND DU LAC, WI 54937 07/01/2021 06/30/2023 3 HORACE MANN HIGH SCHOOL, 325 MCKINLEY ST, FOND DU LAC, WI 54937 07/01/2021 06/30/2023 3 STEM INSTITUTE, 401 S MILITARY RD, FOND DU LAC, WI 54935 07/01/2021 06/30/2023 3 THEISEN MIDDLE SCHOOL, 525 S PIONEER RD, FOND DU LAC, WI 54935 07/01/2021 06/30/2023 3 WOODWORTH MIDDLE SCHOOL, 101 MORNINGSIDE DR, FOND DU LAC, WI 54935 07/01/2021 06/30/2023 3 JR SR HIGH SCHOOL, 801 LINCOLN ST, WAUPUN, WI 53963 07/01/2021 06/30/2023 3 MEADOW VIEW PRIMARY SCHOOL, 506 BEAVER DAM ST, WAUPUN, WI 53963 07/01/2021 06/30/2023 3 ROCK RIVER INTERMEDIATE SCHOOL, 451 E SPRING ST, WAUPUN, WI 53963 07/01/2021 06/30/2023
FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS 2680
459 E FIRST STREET GERI VANEVENHOVEN Initial Cert: 07/18/2006 FOND DU LAC, WI 54935 [email protected] Cert Eff: 08/01/2021 County: Fond Du Lac Phone:(920) 906-4728 Cert Exp: 07/31/2023 Surveyor: Heather Lom Fax: (920) 929-3129
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 62 of 222 Mental Health Program Directory By County, City, and Provider Name
FOND DU LAC COUNTY DEPT OF COMMUNITY PROGRAMS 1350
459 E FIRST STREET GERI VANEVENHOVEN Initial Cert: 07/01/1978 FOND DU LAC, WI 54935 [email protected] Cert Eff: 03/01/2020 County: Fond Du Lac Phone:(920) 929-3500 Cert Exp: 02/28/2022 Surveyor: Heather Lom Fax: (920) 929-3129 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2020 02/28/2022 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2020 02/28/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 CSAS-PREVENTION DHS 75.04 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 MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
ST AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES 1847
430 EAST DIVISION STREET MATTHEW DOLL Initial Cert: 05/01/1980 FOND DU LAC, WI 54935 [email protected] Cert Eff: 01/01/2020 County: Fond Du Lac Phone:(920) 926-4200 Cert Exp: 12/31/2021 Surveyor: Heather Lom Fax: (920) 926-8933
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 01/01/2020 12/31/2021 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2020 12/31/2021 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2020 12/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2020 12/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 AGNESIAN AT MARR, 21 S MARR STREET, FOND DU LAC, WI 54935 01/01/2020 12/31/2021
RIPON RIPON MEDICAL CENTER, A MEMBER OF AGNESIAN HEALTHCARE 3284
845 PARKSIDE STREET MATTHEW DOLL Initial Cert: 05/20/2020 RIPON, WI 54971 [email protected] Cert Eff: 06/01/2021 County: Fond Du Lac Phone:(920) 926-4201 Cert Exp: 05/31/2023 Surveyor: Heather Lom Fax: (920) 926-8933
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 63 of 222 Mental Health Program Directory By County, City, and Provider Name
FOREST CRANDON FOREST COUNTY POTAWATOMI BEHAVIORAL HEALTH DEPARTMENT 1351
8201 MISH KO SWEN DRIVE ANGELA JACOBSON Initial Cert: 04/01/1994 CRANDON, WI 54520 [email protected] Cert Eff: 04/01/2021 County: Forest Phone:(715) 478-4978 Cert Exp: 03/31/2023 Surveyor: Renee DeWitt Fax: (715) 478-4493
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 NO BRANCH LOCATIONS
09/28/2021 Page 64 of 222 Mental Health Program Directory By County, City, and Provider Name
GRANT LANCASTER UNIFIED COMMUNITY SERVICES 1943
200 W ALONA LANE CHERYL KNAPP Initial Cert: 10/01/1975 LANCASTER, WI 53813 [email protected] Cert Eff: 07/01/2019 County: Grant Phone:(608) 723-6357 Cert Exp: 06/30/2021 Surveyor: Tina Dary Fax: (608) 723-4417 Crisis Intervention Services Regional Designation Begin End Lead BAYSIDE CRISIS STABILIZATION SERVICE 01/01/2020 DHS 51.42 MULTI-COUNTY PROGRAM: GRANT, IOWA 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 07/01/2019 06/30/2021 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 07/01/2019 11/29/2019 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2019 11/29/2019 CSAS-PREVENTION DHS 75.04 07/01/2019 06/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2019 11/29/2019 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2019 06/30/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2019 11/29/2019
Tier Branch Location(s) Branch Begin/End Dates 2 UNIFIED COMMUNITY SERVICES, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 53533 07/01/2019 06/30/2021
UNIFIED COMMUNITY SERVICES CCS 3276
200 W ALONA LANE CHERYL KNAPP Initial Cert: 06/01/2020 LANCASTER, WI 53813 [email protected] Cert Eff: 06/01/2020 County: Grant Phone:(608) 723-6357 Cert Exp: 05/31/2021 Surveyor: Tina Dary Fax: (608) 723-4417
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL UNIFIED BOARD DHS 36 06/01/2020 05/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 UNIFIED COMMUNITY SVS DODGEVILLE, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 53533 06/01/2020 05/31/2021
UNIFIED COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM 1941
200 W. ALONA LANE CHERYL KNAPP Initial Cert: 07/01/1994 LANCASTER, WI 53813 [email protected] Cert Eff: 10/01/2020 County: Grant Phone:(608) 723-6357 Cert Exp: 09/30/2022 Surveyor: Tina Dary Fax: (608) 723-4417
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 UNIFIED COMMUNITY SERVICES - CSP, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 53533 10/01/2020 09/30/2022
09/28/2021 Page 65 of 222 Mental Health Program Directory By County, City, and Provider Name
PLATTEVILLE PLATTEVILLE FAMILY RESOURCE CENTER, INC. 1738
1075 N ELM STREET, #120 MARC K. WRUBLE Initial Cert: 09/08/1995 PLATTEVILLE, WI 53818 [email protected] Cert Eff: 04/01/2021 County: Grant Phone:(608) 348-4060 Cert Exp: 09/30/2022 Surveyor: Tina Dary Fax: (608) 348-4191
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 PLATTEVILLE FAM RESOURCE CTR, 219 W MAPLE ST, LANCASTER, WI 53813 04/01/2021 09/30/2022 1 PLATTEVILLE FAMILY RESOURCE CENTER - MOUNT HOREB O, 1406 SPRINGDALE ST. SUITE 102, 04/01/2021 09/30/2022 MOUNT HOREB, WI 53572 2 PLATTEVILLE FAM RESOURCE CR, 218 E SWAYNE ST, STE 200, DODGEVILLE, WI 53533 04/01/2021 09/30/2022 2 PLATTEVILLE FAM RESOURCE CTR-MOUNT HOREB, 1406 SPRINGDALE ST, STE 102, MOUNT 04/01/2021 09/30/2022 HOREB, WI 53572
Non-Certified School Setting(s) Setting Begin/End Dates NEAL WILKINS EARLY LEARNING SCHOOL, 425 BROADWAY ST, PLATTEVILLE, WI 53818 04/01/2021 09/30/2022 PLATTEVILLE HIGH SCHOOL, 710 E MADISON ST, PLATTEVILLE, WI 53818 04/01/2021 09/30/2022 PLATTEVILLE MIDDLE SCHOOL, 40 E MADISON ST, PLATTEVILLE, WI 53818 04/01/2021 09/30/2022 WESTVIEW ELEMENTARY SCHOOL, 1201 CAMP ST, PLATTEVILLE, WI 53818 04/01/2021 09/30/2022 POTOSI SCHOOLS, 128 HIGHWAY 61 N, POTOSI, WI 53820 04/01/2021 09/30/2022
SOUTHWEST BEHAVIORAL SERVICES 2197
1185 NORTH ELM STREET LINDA ZICK Initial Cert: 03/01/2000 PLATTEVILLE, WI 53818 [email protected] Cert Eff: 09/01/2020 County: Grant Phone:(608) 348-3656 Cert Exp: 02/28/2022 Surveyor: Tina Dary Fax: (608) 342-3026
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2020 02/28/2022 NO BRANCH LOCATIONS
SOUTHWEST BEHAVIORAL SERVICES 3130
1450 EAST SIDE ROAD JENNIFER MILLER KASS Initial Cert: 04/25/2016 PLATTEVILLE, WI 53818 [email protected] Cert Eff: 03/01/2020 County: Grant Phone:(608) 648-3656 Cert Exp: 02/28/2022 Surveyor: Tina Dary Fax: (608) 342-3025
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BOSCOBEL CARE AND REHAB, 207 PARKER ST, BOSCOBEL, WI 53805 03/01/2020 02/28/2022 1 SOUTHWEST HEALTH CTR EPIONE PAVILLION, 808 S WASHINGTON ST, CUBA CITY, WI 53807 03/01/2020 02/28/2022 1 BLOOMFIELD MANOR, 3151 COUNTY RD CH, DODGEVILLE, WI 53533 03/01/2020 02/28/2022 1 UPLAND HILLS HEALTH & REHAB CENTER, 800 COMPASSION WAY, DODGEVILLE, WI 53533 03/01/2020 02/28/2022 1 DIVINE CARE AND REHAB, 1850 11TH STREET, FENNIMORE, WI 53809 03/01/2020 02/28/2022 1 LANCASTERHEALTH SERVICES, 1350 S MADISON ST, LANCASTER, WI 53813 03/01/2020 02/28/2022 1 ORCHARD MANOR, 8800 HWY 61, LANCASTER, WI 53813 03/01/2020 02/28/2022 1 MINERAL POINT HEALTH SERVICES, 109 NORTH IOWA ST, MINERAL POINT, WI 53565 03/01/2020 02/28/2022 1 EDENBROOK OF PLATTEVILLE, 1300 NORTH WATER ST, PLATTEVILLE, WI 53818 03/01/2020 02/28/2022
09/28/2021 Page 66 of 222 Mental Health Program Directory By County, City, and Provider Name
GREEN MONROE GREEN COUNTY HUMAN SERVICES 1388
N3152 STATE ROAD 81 ROBERT MILES Initial Cert: 10/01/1975 MONROE, WI 53566 [email protected] Cert Eff: 01/01/2020 County: Green Phone:(608) 328-9393 Cert Exp: 12/31/2021 Surveyor: Tina Dary Fax: (608) 328-2139 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-EMERGENCY OUTPATIENT DHS 75.05 01/01/2020 12/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 CSAS-PREVENTION DHS 75.04 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 GREEN COUNTY ADULT DRUG COURT, 2841 6TH STREET, MONROE, WI 53566 01/01/2020 12/31/2021
GREEN COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2328
N 3152 STATE ROAD 81 MICKEY ROCKEY Initial Cert: 01/01/2000 MONROE, WI 53566 [email protected] Cert Eff: 01/01/2020 County: Green Phone:(608) 328-9399 Cert Exp: 12/31/2021 Surveyor: Tina Dary Fax: (608) 328-9480
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
GREEN/LAFAYETTE REGIONAL COMPREHENSIVE COMMUNITY SERVICES 3085
N3152 STATE RD 81 LISA ANDREAS Initial Cert: 06/01/2015 MONROE, WI 53566 [email protected] Cert Eff: 06/01/2021 County: Green Phone:(608) 328-9353 Cert Exp: 05/31/2023 Surveyor: Tina Dary Fax: (608) 325-2139
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 LAFAYETTE COUNTY HUMAN SERVICES, 15701 CO RD K STE 3, DARLINGTON, WI 53530 06/01/2021 05/31/2023
09/28/2021 Page 67 of 222 Mental Health Program Directory By County, City, and Provider Name
MONROE CLINIC BEHAVIORAL HEALTH 1915
515 - 22ND AVENUE ANDREA GALLAGHER Initial Cert: 05/01/1981 MONROE, WI 53566 [email protected] Cert Eff: 08/01/2021 County: Green Phone:(608) 324-1914 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 324-2102
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 MONROE CLINIC - BRODHEAD, 1ST CENTER AVE, BRODHEAD, WI 53520 08/01/2021 10/31/2021 1 MONROE CLINIC - DURAND BRANCH, 400 S CENTER RD, DURAND, IL 61024 08/01/2021 10/31/2021 1 MONROE CLINIC - FREEPORT BRANCH, 1301 KIWANIS DRIVE, FREEPORT, IL 61032 08/01/2021 10/31/2021 1 MONROE CLINIC - NEW GLARUS BRANCH, 1800 - 2ND ST, NEW GLARUS, WI 53574 08/01/2021 10/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates ABRAHAM LINCOLN ELEMENTARY, 2625 14TH AVE, MONROE, WI 53566 08/01/2021 10/31/2021 MONROE HIGH SCHOOL, 1600 26TH ST, MONROE, WI 53566 08/01/2021 10/31/2021 MONROE MIDDLE SCHOOL, 1510 13TH ST, MONROE, WI 53566 08/01/2021 10/31/2021 NORTHSIDE ELEMENTARY, 3005 8 1/2 ST, MONROE, WI 53566 08/01/2021 10/31/2021 PARKSIDE ELEMENTARY, 920 4TH ST, MONROE, WI 53566 08/01/2021 10/31/2021 MONTICELLO SCHOOL, 334 SOUTH MAIN ST, NEW GLARUS, WI 53574 08/01/2021 10/31/2021 NEW GLARUS ELEMENTARY, 1420 2ND ST, NEW GLARUS, WI 53574 08/01/2021 10/31/2021 NEW GLARUS HIGH SCHOOL, 1701 2ND ST, NEW GLARUS, WI 53574 08/01/2021 10/31/2021
09/28/2021 Page 68 of 222 Mental Health Program Directory By County, City, and Provider Name
GREEN LAKE GREEN LAKE GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES 1389
571 COUNTY ROAD A NICHOL WIENKES Initial Cert: 04/01/1977 GREEN LAKE, WI 54941 [email protected] Cert Eff: 11/01/2020 County: Green Lake Phone:(920) 294-4070 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 294-4139 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2020 10/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 CSAS-PREVENTION DHS 75.04 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2020 10/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BERLIN MIDDLE SCHOOL, 242 MEMORIAL DRIVE, BERLIN, WI 54923 11/01/2020 10/31/2022 GREEN LAKE SCHOOL, 612 MILL STREET, GREEN LAKE, WI 54941 11/01/2020 10/31/2022 MARKENSAN ELEMENTARY, 200 S MARGARET ST, MARKESAN, WI 53946 11/01/2020 10/31/2022 MARKESAN HIGH SCHOOL, 100 E VISTA BLVD, MARKESAN, WI 53946 11/01/2020 10/31/2022
GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP 2265
571 COUNTY ROAD A NICHOL WIENKES Initial Cert: 11/01/2000 GREEN LAKE, WI 54941 [email protected] Cert Eff: 11/01/2019 County: Green Lake Phone:(920) 294-4070 Cert Exp: 10/31/2021 Surveyor: Heather Lom Fax: (920) 294-4139
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
GREEN LAKE COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES 2599
571 COUNTY ROAD A JASON JEROME Initial Cert: 08/22/2005 GREEN LAKE, WI 54941 [email protected] Cert Eff: 04/01/2021 County: Green Lake Phone:(920) 294-4070 Cert Exp: 03/31/2023 Surveyor: Heather Lom Fax: (920) 294-4139
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 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 69 of 222 Mental Health Program Directory By County, City, and Provider Name
IRON HURLEY IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES 2347
300 TACONITE STREET, #201 CALLY BUCKNELL Initial Cert: 03/01/2002 HURLEY, WI 54534 [email protected] Cert Eff: 03/01/2021 County: Iron Phone:(715) 561-3636 Cert Exp: 02/28/2023 Surveyor: Rena Andersen Fax: (715) 561-2128
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 3 HURLEY SCHOOL, 5503 W RANGE VIEW DR, HURLEY, WI 54534 03/01/2021 02/28/2023 3 MERCER SCHOOL, 2690 MARGARET ST, MERCER, WI 54547 03/01/2021 02/28/2023
IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES COMM SUPPORT PROGRAM 2745
300 TACONITE STREET, #201 CALLY BUCKNELL Initial Cert: 03/01/2007 HURLEY, WI 54534 [email protected] Cert Eff: 03/01/2021 County: Iron Phone:(715) 561-3636 Cert Exp: 02/28/2023 Surveyor: Rena Andersen Fax: (715) 561-2128
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
09/28/2021 Page 70 of 222 Mental Health Program Directory By County, City, and Provider Name
JACKSON BLACK RIVER FALLS BLACK RIVER HEALTHCARE CLINIC 3302
711 WEST ADAMS ST ANGELA J MARCIULIONIS Initial Cert: 07/17/2020 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 08/01/2021 County: Jackson Phone:(715) 284-3223 Cert Exp: 07/31/2023 Surveyor: Roderick Senn Fax: (715) 284-3920
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
FAMILY & CHILDREN'S CENTER COMMUNITY SUPPORT PROGRAM - JACKSON COUNTY 3278
421 CTY RD R LIAM BAILEY Initial Cert: 01/01/2020 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 01/01/2021 County: Jackson Phone:(608) 396-6398 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (608) 396-6025
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH 1413
N6520 LUMBER JACK GUY RD EVANGELINE SUQUET Initial Cert: 05/01/1992 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 11/01/2020 County: Jackson Phone:(715) 284-9851 Cert Exp: 10/31/2022 Surveyor: Roderick Senn Fax: (715) 284-3434
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 MADISON BRANCH OFFICE, 4724 TRADE WINDS PARKWAY, MADISON, WI 53718 11/01/2020 10/31/2022
2 WELLNESS CENTER HEALTH OFFICE, S2845 WHITE EAGLE ROAD, BARABOO, WI 53913 11/01/2020 10/31/2022 2 THREE RIVERS HOUSE, 724 MAIN STREET, LA CROSSE, WI 54601 11/01/2020 10/31/2022 2 NEKOOSA HEALTH OFFICE, 1021 COUNTY HWY G, NEKOOSA, WI 54457 11/01/2020 10/31/2022 2 TOMAH HEALTH OFFICE, 430 JULIE ST, STE 2, TOMAH, WI 54660 11/01/2020 10/31/2022 2 WITTENBERG HEALTH OFFICE, W17634 RADKE RD, WITTENBERG, WI 54499 11/01/2020 10/31/2022
JACKSON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES 2957
421 COUNTY RD R JESSICA STINSON Initial Cert: 01/01/2012 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 01/01/2021 County: Jackson Phone:(715) 284-4301 Cert Exp: 08/31/2022 Surveyor: Roderick Senn Fax: (715) 284-7713
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 71 of 222 Mental Health Program Directory By County, City, and Provider Name
JACKSON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES 2901
421 COUNTY RD R JESSICA STINSON Initial Cert: 05/01/2010 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 08/01/2020 County: Jackson Phone:(715) 284-4301 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (715) 284-7713 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 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
KROHN CLINIC, LTD. 1473
610 W ADAMS STREET MINDY GILBERTSON Initial Cert: 02/01/1988 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 05/01/2021 County: Jackson Phone:(715) 284-1887 Cert Exp: 04/30/2023 Surveyor: Roderick Senn Fax: (715) 284-0475
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Non-Certified School Setting(s) Setting Begin/End Dates BLACK RIVER FALLS MIDDLE & HIGH SCOOL, 1200 PIERCE ST, BLACK RIVER FALLS, WI 54615 08/30/2021 04/30/2023
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - BLACK RIVER FALLS 2655
N6643 COUNTY RD A JACKIE MAURER Initial Cert: 02/01/2006 BLACK RIVER FALLS, WI 54615 [email protected] Cert Eff: 02/01/2021 County: Jackson Phone:(715) 284-1100 Cert Exp: 01/31/2023 Surveyor: Roderick Senn Fax: (888) 932-5853
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 72 of 222 Mental Health Program Directory By County, City, and Provider Name
JEFFERSON FORT ATKINSON FORT HEALTH CARE BEHAVIORAL HEALTH 1309
500 MCMILLEN STREET ALICIA LESLIE Initial Cert: 12/01/1991 FORT ATKINSON, WI 53538 [email protected] Cert Eff: 02/01/2021 County: Jefferson Phone:(920) 563-9542 Cert Exp: 01/31/2023 Surveyor: Anastasia E. Vega Fax: (920) 563-4228
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 FORT HEALTHCARE - CAMBRIDGE CLINIC, 704 KATIE COURT, CAMBRIDGE, WI 53523 02/01/2021 01/31/2023 1 FORT HEALTHCARE - LAKE MILLS CLINIC, 200 E TYRANENA PK ROAD, LAKE MILLS, WI 53551 02/01/2021 01/31/2023
2 FORT HEALTHCARE INTEGRATED FAMILY CARE, 1520 MADISON AVE, FORT ATKINSON, WI 53538 02/01/2021 01/31/2023
3 CAMBRIDGE HIGH SCHOOL, 403 BLUE JAY WAY, CAMBRIDGE, WI 53523 02/01/2021 01/31/2023 3 NIKOLAY MIDDLE SCHOOL, 211 SOUTH ST, CAMBRIDGE, WI 53523 02/01/2021 01/31/2023 3 FORT ATKINSON HIGH SCHOOL, 925 LEXINGTON BLVD, FORT ATKINSON, WI 53538 02/01/2021 01/31/2023 3 FORT ATKINSON MIDDLE SCHOOL, 310 4TH ST E, FORT ATKINSON, WI 53538 02/01/2021 01/31/2023 3 LAKEVIEW ELEMENTARY SCHOOL, W8363 R&W TOWNLINE RD, WHITEWATER, WI 53190 02/01/2021 01/31/2023 3 LINCOLN ELEMENTARY SCHOOL, 242 SO PRINCE ST, WHITEWATER, WI 53190 02/01/2021 01/31/2023 3 WASHINGTON ELEMENTARY SCHOOL, 506 E MAIN ST, WHITEWATER, WI 53190 02/01/2021 01/31/2023 3 WHITEWATER HIGH SCHOOL, 534 S ELIZABETH ST, WHITEWATER, WI 53190 02/01/2021 01/31/2023 3 WHITEWATER MIDDLE SCHOOL, 401 S ELIZABETH ST, WHITEWATER, WI 53190 02/01/2021 01/31/2023
09/28/2021 Page 73 of 222 Mental Health Program Directory By County, City, and Provider Name
JEFFERSON JEFFERSON COUNTY HUMAN SERVICES 1449
1541 ANNEX ROAD KATHI CAULEY Initial Cert: 10/01/1975 JEFFERSON, WI 53549 [email protected] Cert Eff: 06/01/2021 County: Jefferson Phone:(920) 674-3105 Cert Exp: 05/31/2023 Surveyor: Anastasia E. Vega Fax: (920) 674-6113 Crisis Intervention Services Regional Designation Begin End Lead BAYSIDE CRISIS STABILIZATION SERVICE 01/01/2020 BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 HARPERS PLACE CRISIS STABILIZATION SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 3 EDGERTON HIGH SCHOOL, 200 ELM HIGH DRIVE, EDGERTON, WI 53534 08/30/2021 05/31/2023 3 EDGERTON MIDDLE SCHOOL, 300 ELM HIGH DRIVE, EDGERTON, WI 53534 08/30/2021 05/31/2023 3 FORT ATKINSON HIGH SCHOOL, 925 LEXINGTON BLVD, FORT ATKINSON, WI 53538 08/30/2021 05/31/2023 3 FORT ATKINSON MIDDLE SCHOOL, 310 S 4TH ST E, FORT ATKINSON, WI 53538 08/30/2021 05/31/2023 3 JEFFERSON HIGH SCHOOL, 700 W MILWAUKEE ST, JEFFERSON, WI 53549 09/13/2021 05/31/2023 3 JEFFERSON MIDDLE SCHOOL, 501 S TAFT AVE, JEFFERSON, WI 53549 09/13/2021 05/31/2023 3 JOHNSON CREEK MIDDLE SCHOOL, 455 AZTALAN ST, JOHNSON CREEK, WI 53038 08/30/2021 05/31/2023 3 WATERLOO HIGH SCHOOL, 813 N MONROE ST, WATERLOO, WI 53594 08/30/2021 05/31/2023 3 WATERLOO MIDDLE SCHOOL, 813 N MONROE ST, WATERLOO, WI 53594 08/30/2021 05/31/2023 3 RIVERSIDE MIDDLE SCHOOL, 131 HALL ST, WATERTOWN, WI 53094 09/13/2021 05/31/2023 3 WATERTOWN HIGH SCHOOL, 825 ENDEAVOUR DR, WATERTOWN, WI 53098 09/13/2021 05/31/2023 3 WHITEWATER MIDDLE SCHOOL, 401 S ELIZABETH ST, WHITEWATER, WI 53190 08/30/2021 05/31/2023
JEFFERSON COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2221
1541 ANNEX ROAD MAJORIE THORMAN Initial Cert: 06/01/2000 JEFFERSON, WI 53549 [email protected] Cert Eff: 01/01/2021 County: Jefferson Phone:(920) 674-8198 Cert Exp: 05/31/2022 Surveyor: Anastasia E. Vega Fax: (920) 674-7409
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 05/31/2022 NO BRANCH LOCATIONS
JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2643
1541 ANNEX ROAD TIFFANY CONGDON Initial Cert: 02/15/2006 JEFFERSON, WI 53549 [email protected] Cert Eff: 03/01/2021 County: Jefferson Phone:(920) 674-1949 Cert Exp: 02/28/2023 Surveyor: Anastasia E. Vega Fax: (920) 674-2359
CCS Affiliaton:JRW TRI COUNTY REGIONAL CCS Begin: 08/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
09/28/2021 Page 74 of 222 Mental Health Program Directory By County, City, and Provider Name
WATERTOWN FAMILY RESOURCES ASSOCIATES, INC. 1326
1315 W MAIN STREET NIKKI KUEFFER Initial Cert: 11/01/1993 WATERTOWN, WI 53094 [email protected] Cert Eff: 05/01/2021 County: Jefferson Phone:(920) 261-4100 Cert Exp: 10/31/2022 Surveyor: Anastasia E. Vega Fax: (920) 261-8801
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 FAMILY RESOURCES ASSOCIATES INC, 248 S. WISCONSIN DRIVE, JEFFERSON, WI 53549 05/01/2021 10/31/2022
09/28/2021 Page 75 of 222 Mental Health Program Directory By County, City, and Provider Name
JUNEAU MAUSTON JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES 1453
200 HICKORY STREET KEVIN LUNOG Initial Cert: 01/01/1988 MAUSTON, WI 53948 [email protected] Cert Eff: 01/01/2020 County: Juneau Phone:(608) 847-9583 Cert Exp: 12/31/2021 Surveyor: Tina Dary Fax: (608) 847-9421 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 HOME YOUTH DIVERSION PROGRAM 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 3000
200 HICKORY STREET BROOKE SCHLUTER Initial Cert: 04/01/2013 MAUSTON, WI 53948 [email protected] Cert Eff: 04/01/2021 County: Juneau Phone:(608) 847-2400 Cert Exp: 03/31/2023 Surveyor: Tina Dary Fax: (608) 847-9421
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 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM 1452
200 HICKORY STREET KIM REIGARD Initial Cert: 01/01/1989 MAUSTON, WI 53948 [email protected] Cert Eff: 12/01/2019 County: Juneau Phone:(608) 847-9546 Cert Exp: 11/30/2021 Surveyor: Tina Dary Fax: (608) 847-9421
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
09/28/2021 Page 76 of 222 Mental Health Program Directory By County, City, and Provider Name
PINE VALLEY INTEGRATED SERVICES LLC 3173
124 GRAYSIDE AVENUE ROBERTA BRONECKI Initial Cert: 07/14/2017 MAUSTON, WI 53948 [email protected] Cert Eff: 09/01/2020 County: Juneau Phone:(608) 350-1135 Cert Exp: 05/31/2022 Surveyor: Tina Dary Fax: (608) 350-1288
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NEW LISBON FAMILY MEDICAL CENTER, 901 BRIDGE ST, NEW LISBON, WI 53950 09/01/2020 05/31/2022
2 MILE BLUFF CLINIC, 1040 DIVISION STREET, MAUSTON, WI 53948 09/01/2020 05/31/2022
3 ADAMS FRIENDSHIP ELEMENTARY SCHOOL, 500 N PIERCE ST, ADAMS, WI 53910 09/01/2020 05/31/2022 3 ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910 09/01/2020 05/31/2022 3 ADAMS FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910 09/01/2020 05/31/2022 3 CAMP DOUGLAS ELEMENTARY, 81 JUNCTION ST, CAMP DOUGLAS, WI 54618 09/01/2020 05/31/2022 3 GRAND MARSH ELEMENTARY, 620 HIGHWAY E, GRAND MARSH, WI 53936 09/01/2020 05/31/2022 3 LYNDON STATION SCHOOL, 201 HOEHN DRIVE, LYNDON STATION, WI 53944 09/01/2020 05/31/2022 3 GRAYSIDE ELEMENTARY SCHOOL, 510 GRAYSIDE AVE, MAUSTON, WI 53948 09/01/2020 05/31/2022 3 ILEAD CHARTER SCHOOL, 800 GRAYSIDE, MAUSTON, WI 53948 09/01/2020 05/31/2022 3 MAUSTON HIGH SCHOOL, 800 GRAYSIDE AVE, MAUSTON, WI 53948 09/01/2020 05/31/2022 3 OLSON MIDDLE SCHOOL, 508 GRAYSIDE AVE, MAUSTON, WI 53948 09/01/2020 05/31/2022 3 WESTSIDE ELEMENTARY, 708 LOOMIS DRIVE, MAUSTON, WI 53948 09/01/2020 05/31/2022 3 CESA JUNEAU CO-ADOLESCENT, 11003 17TH AVE, NECEDAH, WI 54646 09/01/2020 05/31/2022 3 NECEDAH ELEMENTARY SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 54646 09/01/2020 05/31/2022 3 NECEDAH MIDDLE/HIGH SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 54646 09/01/2020 05/31/2022 3 COLUMBIA MARQUETTE CO ADOL NEEDS, W8349 DUMKE ROAD, PORTAGE, WI 53901 09/01/2020 05/31/2022 3 LAGRANGE ELEMENTARY, 600 STRAW ST, TOMAH, WI 54660 09/01/2020 05/31/2022 3 LEMONWEIR ELEMENTARY, 711 N GLENDALE AVE, TOMAH, WI 54660 09/01/2020 05/31/2022 3 MILLER ELEMENTARY, 813 OAK AVE, TOMAH, WI 54660 09/01/2020 05/31/2022 3 OAKDALE ELEMENTARY, 217 S OAKWOOD ST, TOMAH, WI 54660 09/01/2020 05/31/2022 3 ROBERT KUPPER LEARNING CENTER, 1310 TOWNLINE RD, TOMAH, WI 54660 09/01/2020 05/31/2022 3 TOMAH AREA HIGH SCHOOL, 901 LINCOLN AVE, TOMAH, WI 54660 09/01/2020 05/31/2022 3 TOMAH AREA MIDDLE SCHOOL, 612 HOLLISTER AVE, TOMAH, WI 54660 09/01/2020 05/31/2022 3 TOMAH AREA MONTESSORI, 1720 ACADEMY AVE, TOMAH, WI 54660 09/01/2020 05/31/2022 3 TOMAH AREA SCHOOL DISTRICT, 129 W CLIFTON ST, TOMAH, WI 54660 09/01/2020 05/31/2022 3 WOOD COUNTY ALTERNATIVE SCHOOL, CESA 5, 6443 VIRGINIA STREET, VESPER, WI 54489 11/24/2020 05/31/2022 3 WARRENS ELEMENTARY, 409 MAIN ST, WARRENS, WI 54666 09/01/2020 05/31/2022 3 WAUPACA COUNTY ALTERNATIVE PROGRAM, CESA 5, 515 SCHOOL STREET, WAUPACA, WI 54981 11/24/2020 05/31/2022 3 WYEVILLE ELEMENTARY, 225 W TOMAH RD, WYEVILLE, WI 54660 09/01/2020 05/31/2022
09/28/2021 Page 77 of 222 Mental Health Program Directory By County, City, and Provider Name
KENOSHA KENOSHA AALTO ENHANCEMENT CENTER, SC 1083
8503 - 75TH STREET, #A KATHRYN A AALTO Initial Cert: 04/09/1991 KENOSHA, WI 53142 [email protected] Cert Eff: 05/01/2021 County: Kenosha Phone:(262) 654-9370 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 654-9379
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES 2218
12225 - 71ST STREET DONALD NEUMANN Initial Cert: 09/24/1998 KENOSHA, WI 53142 [email protected] Cert Eff: 10/01/2019 County: Kenosha Phone:(414) 773-4374 Cert Exp: 09/30/2021 Surveyor: Anastasia E. Vega Fax: (414) 422-2188
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA - KENOSHA NORTH, 10400 75TH ST STE 106, KENOSHA, WI 53140 08/10/2021 09/30/2021 2 AURORA - RACINE WEST, 8348 WASHINGTON AVE, RACINE, WI 53405 10/01/2019 09/30/2021
CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1193
6809 122ND AVE EDEN CHRISTMAN Initial Cert: 10/01/1993 KENOSHA, WI 53142 [email protected] Cert Eff: 10/01/2021 County: Kenosha Phone:(262) 652-5522 Cert Exp: 09/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 652-7728
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 2 WALWORTH COUNTY CHILD ADVOCACY CENTER, W4063 HWY, NN, ELKHORN, WI 53121 10/01/2021 09/30/2023
INTERCONNECTIONS, S.C. 1440
920 - 60TH STREET SARAH NICHOLS Initial Cert: 08/01/1981 KENOSHA, WI 53140 [email protected] Cert Eff: 01/01/2021 County: Kenosha Phone:(262) 654-5333 Cert Exp: 12/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 654-7818
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 78 of 222 Mental Health Program Directory By County, City, and Provider Name
KENOSHA COMMUNITY HEALTH CENTER, INC 3081
4536 22ND AVENUE CLARE LEWANDOWSKI Initial Cert: 05/01/2015 KENOSHA, WI 53140 [email protected] Cert Eff: 06/01/2021 County: Kenosha Phone:(262) 656-0044 Cert Exp: 05/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 653-2218
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 KENOSHA COMMUNITY HEALTH CENTER - SILVER LAKE, 903 S 2ND STREET, SILVER LAKE, WI 06/01/2021 05/31/2023 53170 2 KENOSHA COMMUNITY HEALTH CENTER - 14TH AVE CLINIC, 6226 14TH AVENUE, KENOSHA, WI 06/01/2021 05/31/2023 53143
KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2589
8600 SHERIDAN RD #100 KATIE HANKS Initial Cert: 05/01/2005 KENOSHA, WI 53143 [email protected] Cert Eff: 05/01/2021 County: Kenosha Phone:(262) 697-4648 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 697-4655
CCS Affiliaton:KENOSHA RACINE REGIONAL CONSORTIUM (KRRC) Begin: 12/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), 3536 52ND STREET, KENOSHA, WI 53144 05/01/2021 04/30/2023
KENOSHA COUNTY DEPT OF HUMAN SERVICES/KENOSHA HUMAN DEVELOPMENT SERVICES INC 1460
3536 52ND STREET WENDY TREFZ Initial Cert: 02/01/1977 KENOSHA, WI 53144 [email protected] Cert Eff: 01/01/2021 County: Kenosha Phone:(262) 764-8555 Cert Exp: 04/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 653-2080 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 04/30/2022 NO BRANCH LOCATIONS
KENOSHA HUMAN DEVELOPMENT SERVICES, INC 2941
3536 52ND STREET ANGELA MARTIN Initial Cert: 10/01/2012 KENOSHA, WI 53144 [email protected] Cert Eff: 06/01/2021 County: Kenosha Phone:(262) 842-0538 Cert Exp: 10/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 842-0539
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 10/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 79 of 222 Mental Health Program Directory By County, City, and Provider Name
KENOSHA HUMAN DEVELOPMENT SERVICES, INC COMMUNITY SUPPORT PROGRAM 2897
3536 52ND STREET YOLANDA THORNTON Initial Cert: 01/01/2010 KENOSHA, WI 53144 [email protected] Cert Eff: 07/01/2021 County: Kenosha Phone:(262) 764-8555 Cert Exp: 12/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 653-2080
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2021 12/31/2022 NO BRANCH LOCATIONS
MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. 2613
6530 SHERIDAN ROAD, #3 TONY MOORE Initial Cert: 09/14/2005 KENOSHA, WI 53143 [email protected] Cert Eff: 10/01/2019 County: Kenosha Phone:(262) 605-1444 Cert Exp: 09/30/2021 Surveyor: Anastasia E. Vega Fax: (262) 605-1404
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2019 09/30/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
OAKWOOD CLINICAL ASSOCIATES, LTD. 2028
4109 67TH STREET AMY ANDERSON Initial Cert: 02/25/1991 KENOSHA, WI 53142 [email protected] Cert Eff: 03/01/2020 County: Kenosha Phone:(262) 652-9830 Cert Exp: 02/28/2022 Surveyor: Anastasia E. Vega Fax: (262) 652-2931
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 2 OAKWOOD CLINICAL ASSOCIATES LTD, 24804 75TH STREET, PADDOCK LAKE, WI 53168 03/01/2020 02/28/2022
09/28/2021 Page 80 of 222 Mental Health Program Directory By County, City, and Provider Name
PROFESSIONAL SERVICES GROUP, INC. 1749
2108 63RD STREET LEAH FEATHERSTONE Initial Cert: 06/01/1983 KENOSHA, WI 53143 [email protected] Cert Eff: 04/01/2020 County: Kenosha Phone:(262) 652-2406 Cert Exp: 03/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 652-2408
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
Tier Branch Location(s) Branch Begin/End Dates 1 PSG - BOYS & GIRLS CLUB OFFICE, N165 W20330 HICKORY LN, JACKSON, WI 53037 04/01/2020 03/31/2022 1 GRANT ELEMENTARY SCHOOL, 1716 35TH ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 1 PSG - BOYS & GIRLS CLUB OFFICE KENOSHA, 1330 52ND ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 1 PSG - THE SHARING CENTER, 25700 WLMOT RD HWY C, TREVOR, WI 53179 04/01/2020 03/31/2022 1 PROFESSIONAL SERVICES GROUP, 614 N 3RD STREET, WAUSAU, WI 54403 04/01/2020 03/31/2022 1 PSG - BOYS & GIRLS CLUB OFFICE, 925 N SILVERBROOK DR, WEST BEND, WI 53090 04/01/2020 03/31/2022
2 PROFESSIONAL SERVICES GROUP, 1905 CENTER AVE, STE 170, JANESVILLE, WI 53546 04/01/2020 03/31/2022 2 PROFESSIONAL SERVICES GROUP, 1205 S 70TH STREET #301, MILWAUKEE, WI 53214 04/01/2020 03/31/2022 2 PROFESSIONAL SERVICES GROUP, 2333 NORTHWESTERN AVE, RACINE, WI 53404 04/01/2020 03/31/2022 2 PROFESSIONAL SERVICES GROUP, 724 ELM STREET, WEST BEND, WI 53095 04/01/2020 03/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BRISTOL ELEMENTARY SCHOOL, 20121 83RD ST, BRISTOL, WI 53104 04/01/2020 03/31/2022 BURLINGTON HIGH SCHOOL, 400 MCCANNA PKWY, BURLINGTON, WI 53105 04/01/2020 03/31/2022 COOPER ELEMENTARY SCHOOL, 249 CONKEY ST, BURLINGTON, WI 53105 04/01/2020 03/31/2022 DYER INTERMEDIATE SCHOOL, 201 S KENDRICK AVE, BURLINGTON, WI 53105 04/01/2020 03/31/2022 KARCHER MIDDLE SCHOOL, 225 ROBERT ST, BURLINGTON, WI 53105 04/01/2020 03/31/2022 LYONS CENTER SCHOOL, 1622 MILL ST, BURLINGTON, WI 53105 04/01/2020 03/31/2022 RANDALL CONSOLIDATED SCHOOL, 37101 87TH ST, BURLINGTON, WI 53105 04/01/2020 03/31/2022 WALLER ELEMENTARY SCHOOL, 195 GARDNER AVE, BURLINGTON, WI 53105 04/01/2020 03/31/2022 WHEATLAND CENTER SCHOOL, 6606 368TH AVE, BURLINGTON, WI 53105 04/01/2020 03/31/2022 WINKLER ELEMENTARY SCHOOL, 34150 FULTON ST, BURLINGTON, WI 53105 04/01/2020 03/31/2022 I4 LEARNING, 5760 MOWHAWK RD, CAMPBELLSPORT, WI 53010 04/01/2020 03/31/2022 AMY BELLE ELEMENTARY, 3294 WILLOW CREEK RD, COLGATE, WI 53017 04/01/2020 03/31/2022 BROOKWOOD ELEMENTARY SCHOOL, 630 KOSSUTH STREET, GENOA CITY, WI 53128 04/01/2020 03/31/2022 BROOKWOOD MIDDLE SCHOOL, 1020 HUNTERS RIDGE DR, GENOA CITY, WI 53128 04/01/2020 03/31/2022 COUNTY LINE ELEMENTARY, W159 N9939 BUTTERNUT RD, GERMANTOWN, WI 53022 04/01/2020 03/31/2022 KENNEDY MIDDLE SCHOOL, W160 N11836 CRUSADER CT, GERMANTOWN, WI 53022 04/01/2020 03/31/2022 MACARTHUR ELEMENTARY SCHOOL, N154 W11942 FOND DU LAC AVE, GERMANTOWN, WI 53022 04/01/2020 03/31/2022 ADDISON ELEMENTARY, 5050 INDIAN ROAD, HARTFORD, WI 53027 04/01/2020 03/31/2022 CENTRAL MIDDLE SCHOOL, 1100 CEDAR ST, HARTFORD, WI 53027 04/01/2020 03/31/2022 DREAM CENTER, 1190 WESTERN DR, HARTFORD, WI 53027 04/01/2020 03/31/2022 EARLY LEARNING CENTER, 244 LOOS ST, HARTFORD, WI 53027 04/01/2020 03/31/2022 HARTFORD UNION HIGH SCHOOL, 805 CEDAR ST, HARTFORD, WI 53027 04/01/2020 03/31/2022 HIGHLAND ALTERNATIVE SCHOOL, 675 E ROSSMAN ST, HARTFORD, WI 53027 04/01/2020 03/31/2022 LINCOLN ELEMENTARY, 755 RURAL ST, HARTFORD, WI 53027 04/01/2020 03/31/2022 ROSSMAN ELEMENTARY, 600 HIGHLAND, HARTFORD, WI 53027 04/01/2020 03/31/2022 JACKSON ELEMENTARY, W204 N16850 JACKSON DR, JACKSON, WI 53037 04/01/2020 03/31/2022 BRIGHTON ELEMENTARY SCHOOL, 1200 248TH AVE, KANSASVILLE, WI 53139 04/01/2020 03/31/2022 BOSE ELEMENTARY SCHOOL, 1900 15TH ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 BRADFORD HIGH SCHOOL, 3700 WASHINGTON RD, KENOSHA, WI 53144 04/01/2020 03/31/2022
09/28/2021 Page 81 of 222 Mental Health Program Directory By County, City, and Provider Name
BRASS ELEMENTARY SCHOOL, 6400 15TH AVE, KENOSHA, WI 53143 04/01/2020 03/31/2022 BULLEN MIDDLE SCHOOL, 2804 39TH AVE, KENOSHA, WI 53144 04/01/2020 03/31/2022 EDWARD BAIN SCHOOL OF LANG & ART, 2600 50TH ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 FRANK ELEMENTARY SCHOOL, 1816 57TH STREET, KENOSHA, WI 53140 04/01/2020 03/31/2022 GREWENOW ELEMENTARY SCHOOL, 7714 20TH AVE, KENOSHA, WI 53143 04/01/2020 03/31/2022 HARBORSIDE ACADEMY, 913 57TH ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 HARVEY ELEMENTARY SCHOOL, 2012 19TH AVE, KENOSHA, WI 53140 04/01/2020 03/31/2022 HILLCREST SCHOOL, 4616 2TH ST, KENOSHA, WI 53144 04/01/2020 03/31/2022 LINCOLN MIDDLE SCHOOL, 6729 18TH AVE, KENOSHA, WI 53143 04/01/2020 03/31/2022 MCKINLEY ELEMENTARY SCHOOL, 5520 32ND AVE, KENOSHA, WI 53144 04/01/2020 03/31/2022 REUTHER CENTRAL HIGH SCHOOL, 913 57TH ST, KENOSHA, WI 53140 04/01/2020 03/31/2022 SOMERS ELEMENTARY SCHOOL, 1245 72ND AVE, KENOSHA, WI 53144 04/01/2020 03/31/2022 SOUTHPORT ELEMENTARY SCHOOL, 723 76TH ST, KENOSHA, WI 53143 04/01/2020 03/31/2022 STOCKER ELEMENTARY SCHOOL, 6315 67TH ST, KENOSHA, WI 53142 04/01/2020 03/31/2022 TREMPOR HIGH SCHOOL, 8560 26TH AVE, KENOSHA, WI 53143 04/01/2020 03/31/2022 WASHINGTON MIDDLE SCHOOL, 811 WASHINGTON RD, KENOSHA, WI 53140 04/01/2020 03/31/2022 WILSON ELEMENTARY SCHOOL, 4520 33RD AVE, KENOSHA, WI 53144 04/01/2020 03/31/2022 FARMINGTON ELEMENTARY, 8736 BOLTONVILLE RD, KEWASKUM, WI 53040 04/01/2020 03/31/2022 KEWAKSUM MIDDLE SCHOOL, 1676 REIGLE DR, KEWASKUM, WI 53040 04/01/2020 03/31/2022 KEWASKUM ELEMENTARY, 1415 BILGO LANE, KEWASKUM, WI 53040 04/01/2020 03/31/2022 DOTTKE HIGH SCHOOL, 7815 W LAPHAM ST, MILWAUKEE, WI 53214 04/01/2020 03/31/2022 LANE ELEMENTARY, 2015 S SUNNYSLOPE RD, NEW BERLIN, WI 53151 04/01/2020 03/31/2022 RIVERVIEW ELEMENTARY SCHOOL, 300 E PROSSER ST, SILVER LAKE, WI 53170 04/01/2020 03/31/2022 SLINGER ELEMENTARY SCHOOL, 203 POLK ST, SLINGER, WI 53086 04/01/2020 03/31/2022 SLINGER MIDDLE SCHOOL, 521 OLYMPIC DR, SLINGER, WI 53086 04/01/2020 03/31/2022 TREVOR-WILMOT GRADE SCHOOL, 26325 WILMOT RD, TREVOR, WI 53179 04/01/2020 03/31/2022 LAKEWOOD ELEMENTARY SCHOOL, 1218 WILMOT AVE, TWIN LAKES, WI 53181 04/01/2020 03/31/2022 UNION GROVE ELEMENTARY SCHOOL, 1745 MILLDRUM ST, UNION GROVE, WI 53182 04/01/2020 03/31/2022 CENTRAL HIGH SCHOOL, 8516 W LINCOLN AVE, WEST ALLIS, WI 53227 04/01/2020 03/31/2022 HORACE MANN ELEMENTARY, 6213 W LAPHAM ST, WEST ALLIS, WI 53214 04/01/2020 03/31/2022 IRVING ELEMENTARY, 10230 W GRANT ST, WEST ALLIS, WI 53227 04/01/2020 03/31/2022 JEFFERSON ELEMENTARY, 7229 W BECHER ST, WEST ALLIS, WI 53219 04/01/2020 03/31/2022 MADISON ELEMENTARY, 1117 104TH ST, WEST ALLIS, WI 53214 04/01/2020 03/31/2022 MITCHELL ELEMENTARY, 10215 W MONTANA AVE, WEST ALLIS, WI 53227 04/01/2020 03/31/2022 NATHAN HALE HIGH SCHOOL, 11601 W LINCOLN AVE, WEST ALLIS, WI 53227 04/01/2020 03/31/2022 WALKER ELEMENTARY, 900 S 119TH ST, WEST ALLIS, WI 53214 04/01/2020 03/31/2022 BADGER MIDDLE SCHOOL, 727 S 6TH AVE, WEST BEND, WI 53095 04/01/2020 03/31/2022 DECORAH ELEMENTARY, 1225 SULVAN WAY, WEST BEND, WI 53095 04/01/2020 03/31/2022 FAIRPARK ELEMENTARY SCHOOL, 519 INDIANA AVE, WEST BEND, WI 53095 04/01/2020 03/31/2022 GREAT EXPECTATIONS, 735 MAIN ST, WEST BEND, WI 53095 04/01/2020 03/31/2022 GREEN TREE ELEMENTARY, 1330 GREEN TREE RD, WEST BEND, WI 53095 04/01/2020 03/31/2022 HEADSTART, 737 S 3RD AVE, WEST BEND, WI 53095 04/01/2020 03/31/2022 MCLANE ELEMENTARY, 833 CHESTNUT ST, WEST BEND, WI 53095 04/01/2020 03/31/2022 PATHWAYS CHARTER, 1043 S MAIN ST, WEST BEND, WI 53095 04/01/2020 03/31/2022 SILVERBROOK INTERMEDIATE, 120 N SILVERBROOK RD, WEST BEND, WI 53095 04/01/2020 03/31/2022 WEST BEND EAST HIGH SCHOOL, 1305 E DECORAH RD, WEST BEND, WI 53095 04/01/2020 03/31/2022 PERSHING ELEMENTARY SCHOOL, 1330 S 47TH ST, WEST MILWAUKEE, WI 53214 04/01/2020 03/31/2022 WILMOT UNION HIGH SCHOOL, 11112 308TH AVE, WILMOT, WI 53192 04/01/2020 03/31/2022
09/28/2021 Page 82 of 222 Mental Health Program Directory By County, City, and Provider Name
PSYCHIATRIC AND PSYCHOTHERAPY CLINIC 1752
6125 GREEN BAY RD, STE 700 LISA DEFAZIO Initial Cert: 06/01/1980 KENOSHA, WI 53142 [email protected] Cert Eff: 01/01/2021 County: Kenosha Phone:(262) 654-0487 Cert Exp: 04/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 654-2434
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM 2433
9916 - 75TH STREET MAEVE O'NEILL Initial Cert: 04/28/2003 KENOSHA, WI 53142 [email protected] Cert Eff: 09/15/2020 County: Kenosha Phone:(262) 942-4000 Cert Exp: 04/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 942-7740
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 09/15/2020 04/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/15/2020 04/30/2022 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/15/2020 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/15/2020 04/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/15/2020 04/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 83 of 222 Mental Health Program Directory By County, City, and Provider Name
KEWAUNEE KEWAUNEE KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES CSP 2288
810 LINCOLN STREET SUE NORTON Initial Cert: 02/01/1977 KEWAUNEE, WI 54216 [email protected] Cert Eff: 02/01/2021 County: Kewaunee Phone:(920) 388-7030 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (920) 388-7124
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
KEWAUNEE COUNTY DEPT OF HUMAN SERVICES 1466
810 LINCOLN STREET SUE NORTON Initial Cert: 02/01/1977 KEWAUNEE, WI 54216 [email protected] Cert Eff: 02/01/2021 County: Kewaunee Phone:(920) 388-7030 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (920) 388-7124 Crisis Intervention Services Regional Designation Begin End Lead FAMILY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2021 01/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 CSAS-PREVENTION DHS 75.04 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES 2781
810 LINCOLN STREET SUE NORTON Initial Cert: 03/11/2008 KEWAUNEE, WI 54216 [email protected] Cert Eff: 04/01/2021 County: Kewaunee Phone:(920) 388-7030 Cert Exp: 03/31/2023 Surveyor: Renee DeWitt Fax: (920) 388-7124
CCS Affiliaton:LAKESHORE RECOVERY CONSORTIUM Begin: 12/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 84 of 222 Mental Health Program Directory By County, City, and Provider Name
LA CROSSE LA CROSSE BRAVE SPACES COUNSELING & WELLNESS 3334
605 4TH STREET S NICOLE MILLIREN Initial Cert: 06/10/2021 LA CROSSE, WI 54601 [email protected] Cert Eff: 06/10/2021 County: La Crosse Phone:(608) 386-5495 Cert Exp: 05/31/2022 Surveyor: Roderick Senn Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/10/2021 05/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates SPENCE ELEMENTARY, 2150 BENNET ST, LA CROSSE, WI 54601 06/10/2021 05/31/2022
COUNSELING ASSOCIATES LLC 2802
115 - 5TH AVENUE SOUTH, #301 DAVID HOULIHAN Initial Cert: 06/05/2008 LA CROSSE, WI 54601 [email protected] Cert Eff: 01/01/2021 County: La Crosse Phone:(608) 785-0827 Cert Exp: 05/31/2022 Surveyor: Roderick Senn Fax: (608) 785-0273
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 01/02/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN 55987 01/01/2021 05/31/2022
DRIFTLESS RECOVERY SERVICES INC 3021
444 MAIN ST SUITE 301 BRENT KNUTSON Initial Cert: 04/14/2014 LA CROSSE, WI 54601 [email protected] Cert Eff: 04/01/2021 County: La Crosse Phone:(608) 519-5906 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (608) 519-5908
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 NO BRANCH LOCATIONS
FAMILY & CHILDREN'S CENTER COMMUNITY SUPPORT PROGRAM - LA CROSSE COUNTY 3279
1707 MAIN STREET LIAM BAILEY Initial Cert: 01/01/2020 LA CROSSE, WI 54601 [email protected] Cert Eff: 01/01/2021 County: La Crosse Phone:(605) 785-0001 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (608) 791-6262
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 85 of 222 Mental Health Program Directory By County, City, and Provider Name
FAMILY AND CHILDREN'S CENTER 1315
1707 MAIN STREET MARY JACOBSON Initial Cert: 02/01/1994 LA CROSSE, WI 54601 [email protected] Cert Eff: 11/01/2019 County: La Crosse Phone:(608) 785-0001 Cert Exp: 10/31/2021 Surveyor: Roderick Senn Fax: (608) 785-0002
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 FAMILY AND CHILDREN'S CENTER, 920 W WISCONSIN ST, STE 3, SPARTA, WI 54656 08/11/2020 10/31/2021 2 FAMILY AND CHILDREN'S CENTER, 1321 N MAIN STREET, VIROQUA, WI 54665 11/12/2019 10/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD., LA CROSSE, WI 54601 11/01/2019 10/31/2021 HAMILTON EARLY LEARNING CTR, 1111 S. 7TH STREET, LA CROSSE, WI 54601 11/01/2019 10/31/2021 SPENCE ELEMENTARY, 2150 BENNETT STREET, LA CROSSE, WI 54601 11/01/2019 10/31/2021 LOGAN HIGH SCHOOL, 1500 RANGER DR, LACROSSE, WI 54603 11/01/2019 10/31/2021 NORTHSIDE ELEMENTARY, 1611 KANE ST, LACROSSE, WI 54603 11/01/2019 10/31/2021
GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH 1391
1836 SOUTH AVENUE MOLLIE MCRAE Initial Cert: 02/01/1984 LA CROSSE, WI 54601 [email protected] Cert Eff: 02/01/2021 County: La Crosse Phone:(608) 775-4161 Cert Exp: 01/31/2023 Surveyor: Roderick Senn Fax: (608) 775-2222
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 GUNDERSEN CLINIC LTD, 420 SOUTH PETERSON AVE, BLAIR, WI 54616 02/01/2021 01/31/2023 1 GUNDERSEN HARMONY CLINIC, 805 COUNTY RD 44, HARMONY, MN 55939 02/01/2021 01/31/2023 1 GUNDERSEN HOUSTON CLINIC, 511 E MAPLE ST, HOUSTON, MN 55943 02/01/2021 01/31/2023 1 GUNDERSEN CLINIC LTD, 35791 OSSEO ROAD, INDEPENDENCE, WI 54747 02/01/2021 01/31/2023 1 GUNDERSEN CLINIC LTD, 226 NORTH 2ND STREET, LA CRESCENT, MN 55947 02/01/2021 01/31/2023 1 RICHLAND MEDICAL CENTER, 301 EAST 2ND STREET, RICHLAND CENTER, WI 53581 02/01/2021 01/31/2023 1 GUNDERSEN SPRING GROVE CLINIC, 123 5TH AVE SE, SPRING GROVE, MN 55974 02/01/2021 01/31/2023 1 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 54665 02/01/2021 01/31/2023
2 GUNDERSEN CLINIC LTD, 1830 STATE HWY 9, DECORAH, IA 52101 02/01/2021 01/31/2023 2 DAHL FAMILY YMCA, 1140 MAIN ST, LA CROSSE, WI 54601 02/01/2021 01/31/2023 2 GUNDERSEN LUTHERAN MEDICAL CENTER, 123 - 16TH AVE SOUTH, ONALASKA, WI 54650 02/01/2021 01/31/2023 2 GUNDERSEN LUTHERAN MEDICAL CENTER, 3111 GUNDERSEN DRIVE, ONALASKA, WI 54650 02/01/2021 01/31/2023 2 GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 53821 02/01/2021 01/31/2023 2 GUNDERSEN CLINIC LTD BEHAVIORAL HLTH, 1111 W WISCONSIN ST, SPARTA, WI 54656 02/01/2021 01/31/2023 2 GUNDERSEN CLINIC LTD, 505 GOPHER DRIVE, TOMAH, WI 54660 02/01/2021 01/31/2023 2 GUNDERSEN VIROQUA CLINIC, 407 SOUTH MAIN STREET, VIROQUA, WI 54665 02/01/2021 01/31/2023 2 GUNDERSEN CLINIC LTD, 18606 ERVIN STREET, WHITEHALL, WI 54773 02/01/2021 01/31/2023 2 GUNDERSEN HEALTH SYSTEM - WINONA, 1122 W HWY 61, WINONA, MN 55987 02/01/2021 01/31/2023
09/28/2021 Page 86 of 222 Mental Health Program Directory By County, City, and Provider Name
GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH 1520
1910 SOUTH AVENUE MOLLIE MCRAE Initial Cert: 03/01/1982 LA CROSSE, WI 54601 [email protected] Cert Eff: 02/01/2021 County: La Crosse Phone:(608) 775-4161 Cert Exp: 01/31/2023 Surveyor: Roderick Senn Fax: (608) 775-2222
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 02/01/2021 01/31/2023 CSAS-NARCOTIC TREATMENT DHS 75.15 02/01/2021 01/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 02/24/2021 01/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 GUNDERSEN LMC CTR FOR VIOL PRE & INTER, 914 GREEN BAY ST, LA CROSSE, WI 54601 02/01/2021 01/31/2023 2 GUNDERSEN LMC BEHAV HEALTH, 123 - 16TH AVENUE SO, ONALASKA, WI 54650 02/01/2021 01/31/2023 2 GUNDERSEN LMC BEHAV HEALTH, 18606 ERVIN ST, WHITEHALL, WI 54773 02/01/2021 01/31/2023
LA CROSSE COUNTY HUMAN SERVICES 1488
300 N 4TH STREET DIANE OINES Initial Cert: 02/01/1978 LA CROSSE, WI 54601 [email protected] Cert Eff: 01/01/2021 County: La Crosse Phone:(608) 785-6129 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (608) 785-6122 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 TELLURIAN INC CRISIS STABILIZATION SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 LAKEVIEW HEALTH CENTER, 848 GARLAND STREET EAST, WEST SALEM, WI 54669 01/01/2021 04/30/2022 1 RAVENWOOD, 848 GARLAND STREET EAST, WEST SALEM, WI 54669 01/01/2021 04/30/2022
09/28/2021 Page 87 of 222 Mental Health Program Directory By County, City, and Provider Name
MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC 1362
615 10TH STREET SOUTH JOHN SOWDERS Initial Cert: 09/01/1977 LA CROSSE, WI 54601 [email protected] Cert Eff: 06/01/2021 County: La Crosse Phone:(608) 392-9555 Cert Exp: 05/31/2023 Surveyor: Roderick Senn Fax: (608) 392-9793
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 MAYO CLINIC FRANSISCAN - ARCADIA, 895 SO DETTLOFF DRIVE, ARCADIA, WI 54612 06/01/2021 05/31/2023 2 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 1303 MAIN STREET, HOLMEN, WI 54636 06/01/2021 05/31/2023 2 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 54601 06/01/2021 05/31/2023 2 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 54650 06/01/2021 05/31/2023 2 MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU 06/01/2021 05/31/2023 CHIEN, WI 53821 2 MAYO CLINIC FRANCISCAN - SPARTA, 310 WEST MAIN STREET, SPARTA, WI 54656 06/01/2021 05/31/2023 2 MAYO CLINIC FRANCISCAN - TOMAH, 325 BUTTS AVENUE, TOMAH, WI 54660 06/01/2021 05/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates HAMILTON EARLY LEARNING CENTER, 1111 7TH ST. S., LA CROSSE, WI 54601 06/01/2021 05/31/2023
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PEACE OF MIND COUNSELING 3005
115 - 5TH AVENUE SOUTH, SUITE 507 JAY CLARK Initial Cert: 08/01/2013 LA CROSSE, WI 54601 [email protected] Cert Eff: 02/01/2021 County: La Crosse Phone:(608) 797-5679 Cert Exp: 07/31/2022 Surveyor: Roderick Senn Fax: (608) 782-4426
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 PEACE OF MIND - BLACK RIVER FALLS, 920 FILLMORE ST, BLACK RIVER FALLS, WI 54615 02/01/2021 07/31/2022 2 PEACE OF MIND - LA CRESCENT, 136 S WALNUT ST, LA CRESCENT, MN 55947 02/01/2021 07/31/2022 2 PEACE OF MIND - SPARTA, 107 E OAK ST, SPARTA, WI 54656 02/01/2021 07/31/2022
3 LINCOLN MS/HS, 124 S SCHOOL STREET, ALMA CENTER, WI 54611 02/01/2021 07/31/2022 3 ARCADIA ELEMENTARY SCHOOL, 358 EAST RIVER ST, ARCADIA, WI 54612 02/01/2021 07/31/2022 3 ARCADIA MIDDLE/HIGH SCHOOL, 756 RAIDER DR, ARCADIA, WI 54612 02/01/2021 07/31/2022 3 BLACK RIVER FALLS HIGH SCHOOL, 1200 PIERCE STREET, BLACK RIVER FALLS, WI 54615 02/01/2021 07/31/2022 3 BLACK RIVER FALLS MIDDLE SCHOOL, 1202 PIERCE ST, BLACK RIVER FALLS, WI 54615 02/01/2021 07/31/2022 3 FORREST STREET EARLY LEARNING CENTER, 720 FORREST ST, BLACK RIVER FALLS, WI 54615 02/01/2021 07/31/2022 3 RED CREEK ELEMENTARY, 410 HIGHWAY A, BLACK RIVER FALLS, WI 54615 02/01/2021 07/31/2022 3 BLAIR-TAYLOR SCHOOL DISTRICT, N31024 ELLAND ROAD, BLAIR, WI 54616 02/01/2021 07/31/2022 3 CASHTON ELEMENTARY, 436 FRONT ST, CASHTON, WI 54619 02/01/2021 07/31/2022 3 DE SOTO MIDDLE/HIGH SCHOOL, 615 MAIN ST, DE SOTO, WI 54624 02/01/2021 07/31/2022 3 COCHRANE-FOUNTAIN CITY SCHOOL DISTRICT, S2770 STATE HIWY 35, FOUNTAIN CITY, WI 54629 02/01/2021 07/31/2022 3 COULEE REGION ALTERNATIVE SCHOOL, 20873 COLLEGE AVENUE, GALESVILLE, WI 54630 02/01/2021 07/31/2022 3 G-E-T ELEMENTARY SCHOOL - GALESVILLE, 17151 FRENCH RD, GALESVILLE, WI 54630 02/01/2021 07/31/2022 3 G-E-T HIGH SCHOOL, 17511 NORTH MAIN ST, GALESVILLE, WI 54630 02/01/2021 07/31/2022 3 G-E-T MIDDLE SCHOOL, 19650 PRAIRIE RIDGE LANE, GALESVILLE, WI 54630 02/01/2021 07/31/2022 3 EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 HOLMEN HIGH SCHOOL, 1001 MCHUGH ROAD, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 HOLMEN MIDDLE SCHOOL, 502 N MAIN STREET, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 PRAIRIE VIEW ELEMENTARY, 1201 NEWPORT LANE, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 SAND LAKE ELEMENTARY, 3600 SAND LAKE ROAD, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI 54636 02/01/2021 07/31/2022 3 INDEPENDENCE K-12, 23786 INDEE BLVD, INDEPENDENCE, WI 54747 02/01/2021 07/31/2022 3 LA CRESCENT ELEMENTARY, 504 SOUTH OAK STREET, LA CRESCENT, MN 55947 02/01/2021 07/31/2022 3 LA CRESCENT MS/HS, 1301 LANCER BLVD, LA CRESCENT, MN 55947 02/01/2021 07/31/2022 3 CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 COULEE CONNECTIONS, 99 MILWAUKEE ST, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 EMERSON ELEMENTARY SCHOOL, 2102 CAMPBELL ROAD, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 LOGAN HIGH SCHOOL, 1500 RANGER DR, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 NORTHSIDE ELEMENTARY, 1611 KANE ST, LA CROSSE, WI 54601 02/01/2021 07/31/2022 3 LINCOLN ELEMENTARY SCHOOL, 207 EAST PEARL, MERRILLAN, WI 54754 02/01/2021 07/31/2022 3 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650 02/01/2021 07/31/2022 3 ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI 54650 02/01/2021 07/31/2022 3 CATARACT ELEMENTARY SCHOOL, 6070 STATE HWY 27, SPARTA, WI 54656 02/01/2021 07/31/2022 3 HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 LAKEVIEW MONTESSORI SCHOOL, 711 PINE ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 LAWRENCE-LAWSON ELEMENTARY SCHOOL, 429 N BLACK RIVER ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 MAPLEWOOD ELEMENTARY SCHOOL, 900 E MONTGOMERY ST, SPARTA, WI 54656 02/01/2021 07/31/2022
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3 MEADOWVIEW INTERMEDIATE SCHOOL, 125 N WATER ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 SOUTHSIDE ELEMENTARY, 1023 WALRATH ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 SPARTA ALT IND LEARNING SCHOOLS (SAILS), 201 E FRANKLIN ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 SPARTA HIGH SCHOOL, 506 N BLACK RIVER ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 SPARTA MEADOWVIEW MIDDLE SCHOOL, 1225 N BLACK RIVER ST, SPARTA, WI 54656 02/01/2021 07/31/2022 3 STODDARD ELEMENTARY SCHOOL, 300 N. COTTAGE ST., STODDARD, WI 54658 02/01/2021 07/31/2022 3 WHITEHALL SCHOOL DISTRICT, 19121 HOBSON ST, WHITEHALL, WI 54773 02/01/2021 07/31/2022
WESTERN REGION INTEGRATED CARE CCS 3044
300 - 4TH STREET NORTH EMILY ENGLING Initial Cert: 07/04/2014 LA CROSSE, WI 54602 [email protected] Cert Eff: 04/01/2021 County: La Crosse Phone:(608) 785-6019 Cert Exp: 06/30/2022 Surveyor: Roderick Senn Fax: (608) 785-6122
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 04/01/2021 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 JACKSON COUNTY HUMAN SERVICES - CCS, 421 COUNTY RD R, BLACK RIVER FALLS, WI 54615 04/01/2021 06/30/2022 2 MONROE COUNTY HUMAN SERVICES CCS, 112 S COURT ST RM 3000, SPARTA, WI 54656 04/01/2021 06/30/2022
ONALASKA ECLECTIC COUNSELING 3297
704 SAND LAKE ROAD SUITE 205 BILLIE JO M JESTER Initial Cert: 07/29/2021 ONALASKA, WI 54650 [email protected] Cert Eff: 07/29/2021 County: La Crosse Phone:(608) 519-1400 Cert Exp: 07/31/2023 Surveyor: Roderick Senn Fax: (608) 519-0446
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/29/2021 07/31/2023 NO BRANCH LOCATIONS
GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH 2280
123 - 16TH AVENUE, SOUTH MOLLIE MCRAE Initial Cert: 12/01/2000 ONALASKA, WI 54650 [email protected] Cert Eff: 12/01/2020 County: La Crosse Phone:(608) 775-4161 Cert Exp: 11/30/2022 Surveyor: Roderick Senn Fax: (608) 775-6055
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2020 11/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
LIVING WELL CHRISTIAN FAMILY CLINIC, LLC 2778
575 LESTER AVENUE STE #100 JOSHUA LIPPS Initial Cert: 04/01/2008 ONALASKA, WI 54650 [email protected] Cert Eff: 04/01/2021 County: La Crosse Phone:(608) 783-1452 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (608) 783-1456
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 90 of 222 Mental Health Program Directory By County, City, and Provider Name
STEIN COUNSELING AND CONSULTING SERVICES, LTD 2467
571 BRAUND STREET KIM J STEIN Initial Cert: 08/06/2003 ONALASKA, WI 54650 [email protected] Cert Eff: 09/01/2021 County: La Crosse Phone:(608) 785-7000 Cert Exp: 08/31/2023 Surveyor: Roderick Senn Fax: (608) 785-7477
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 3 EAGLE BLUFF ELEMENTARY, 200 EAGLE BLUFF CT, ONALASKA, WI 54650 09/01/2021 08/31/2023 3 IRVING PERTZCH ELEMENTARY, 524 MAIN ST, ONALASKA, WI 54650 09/01/2021 08/31/2023 3 NORTHERN HILLS ELEMENTARY, 910 EAST AVE NORTH, ONALASKA, WI 54650 09/01/2021 08/31/2023 3 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PL, ONALASKA, WI 54650 09/01/2021 08/31/2023 3 ONALASKA MIDDLE, 711 QUINCY ST, ONALASKA, WI 54650 09/01/2021 08/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD S, LA CROSSE, WI 54601 09/01/2021 08/31/2023 EMERSON ELEMENTARY, 2101 CAMPBELL RD, LA CROSSE, WI 54601 09/01/2021 08/31/2023 HAMILTON ELEMENTARY, 111 7TH STREET S, LA CROSSE, WI 54601 09/01/2021 08/31/2023 LINCOLN MIDDLE SCHOOL, 510 9TH STREET S, LA CROSSE, WI 54601 09/01/2021 08/31/2023 LOGAN HIGH SCHOOL, 1500 RANGOR DR, LA CROSSE, WI 54603 09/01/2021 08/31/2023 LOGAN MIDDLE SCHOOL, 1450 AVON ST, LA CROSSE, WI 54601 09/01/2021 08/31/2023 LONGFELLOW MIDDLE SCHOOL, 1900 DENTON ST, LA CROSSE, WI 54601 09/01/2021 08/31/2023 NORTHSIDE ELEMENTARY, 1611 KANE ST, LA CROSSE, WI 54603 09/01/2021 08/31/2023
09/28/2021 Page 91 of 222 Mental Health Program Directory By County, City, and Provider Name
LAFAYETTE DARLINGTON LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES 1490
15701 COUNTY ROAD K STE 3 SHANE SCHUHMACHER Initial Cert: 10/01/1975 DARLINGTON, WI 53530 [email protected] Cert Eff: 11/01/2019 County: Lafayette Phone:(608) 776-4909 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 776-4914 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 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 OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2279
15701 COUNTY ROAD K SHANE SCHUHMACHER Initial Cert: 11/01/2000 DARLINGTON, WI 53530 [email protected] Cert Eff: 11/01/2019 County: Lafayette Phone:(608) 776-4909 Cert Exp: 10/31/2021 Surveyor: Tina Dary Fax: (608) 776-4914
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 92 of 222 Mental Health Program Directory By County, City, and Provider Name
LANGLADE ANTIGO LANGLADE HOSPITAL GENERAL CLINIC 2890
110 E FIFTH AVENUE NICKI WILLIAMS Initial Cert: 07/27/2010 ANTIGO, WI 54409 [email protected] Cert Eff: 08/01/2021 County: Langlade Phone:(715) 627-6100 Cert Exp: 07/31/2023 Surveyor: Renee DeWitt Fax: (715) 627-6183
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS ELCHO WETZEL-RASMUSSEN COUNSELING SERVICES 2533
W10610 CLINIC ST. NATALIE WETZEL-RASMUSSEN Initial Cert: 07/01/2004 ELCHO, WI 54428 [email protected] Cert Eff: 07/01/2021 County: Langlade Phone:(715) 275-3934 Cert Exp: 06/30/2023 Surveyor: Renee DeWitt Fax: (715) 275-4533
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023
Non-Certified School Setting(s) Setting Begin/End Dates ELCHO SCHOOL DISTRICT, N11268 ANTIGO STREET, ELCHO, WI 54428 07/01/2021 06/30/2023
09/28/2021 Page 93 of 222 Mental Health Program Directory By County, City, and Provider Name
LINCOLN TOMAHAWK PSYCHOLOGICAL RESOURCE CENTER, LLC 2806
1218 N 4TH STREET, #108 ELIZABETH K MCCLUSKEY Initial Cert: 10/01/2008 TOMAHAWK, WI 54487 [email protected] Cert Eff: 10/01/2020 County: Lincoln Phone:(715) 224-2100 Cert Exp: 09/30/2022 Surveyor: Rena Andersen Fax: (715) 224-2106
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 TOMAHAWK SCHOOLS, 1048 EAST KING RD, TOMAHAWK, WI 54487 10/01/2020 09/30/2022
09/28/2021 Page 94 of 222 Mental Health Program Directory By County, City, and Provider Name
MANITOWOC MANITOWOC CORE TREATMENT SERVICES, INC 3288
3 RIVERVIEW DR CARMEN PERSAUD Initial Cert: 03/06/2020 MANITOWOC, WI 54220 [email protected] Cert Eff: 03/01/2021 County: Manitowoc Phone:(920) 645-1411 Cert Exp: 02/28/2023 Surveyor: Renee DeWitt Fax: () -
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 03/01/2021 02/28/2023 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2021 02/28/2023 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 2 CORE TREATMENT SERVICES, INC, 3733 DEWEY ST., MANITOWOC, WI 54220 05/19/2021 02/28/2023
MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT 1555
926 S. 8TH STREET LORI FURE Initial Cert: 10/01/1975 MANITOWOC, WI 54220 [email protected] Cert Eff: 11/01/2019 County: Manitowoc Phone:(920) 683-4230 Cert Exp: 10/31/2021 Surveyor: Renee DeWitt Fax: (920) 683-4243 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 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 11/01/2019 10/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/01/2019 11/29/2019 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2019 11/29/2019 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT CSP 2285
926 S. 8TH STREET LORI FURE Initial Cert: 10/01/1975 MANITOWOC, WI 54220 [email protected] Cert Eff: 11/01/2019 County: Manitowoc Phone:(920) 683-4230 Cert Exp: 10/31/2021 Surveyor: Renee DeWitt Fax: (920) 683-4243
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2019 11/29/2019 NO BRANCH LOCATIONS
09/28/2021 Page 95 of 222 Mental Health Program Directory By County, City, and Provider Name
MANITOWOC COUNTY HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES 2711
926 S. 8TH STREET LORI FURE Initial Cert: 02/06/2007 MANITOWOC, WI 54220 [email protected] Cert Eff: 03/01/2021 County: Manitowoc Phone:(920) 683-4230 Cert Exp: 02/28/2023 Surveyor: Renee DeWitt Fax: (920) 683-4243
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2021 02/28/2023 NO BRANCH LOCATIONS TWO RIVERS AURORA BEHAVIORAL HEALTH CENTER - MANITOWOC 1386
5300 MEMORIAL DRIVE SARAH DONOVAN Initial Cert: 09/01/1993 TWO RIVERS, WI 54241 [email protected] Cert Eff: 04/01/2020 County: Manitowoc Phone:(920) 403-8061 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (920) 403-8209
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2020 03/31/2022 NO BRANCH LOCATIONS
PHOENIX BEHAVIORAL HEALTH SERVICES, LLC 1591
3120 MEMORIAL DRIVE KRISTA WILCOX Initial Cert: 08/26/1991 TWO RIVERS, WI 54241 [email protected] Cert Eff: 11/01/2020 County: Manitowoc Phone:(920) 657-1780 Cert Exp: 10/31/2022 Surveyor: Renee DeWitt Fax: (920) 657-1784
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 1600 SHAWANO AVE #100, GREEN BAY, WI 54303 11/01/2020 10/31/2022 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 2619 C POST ROAD STE 2, STEVENS POINT, WI 11/01/2020 10/31/2022 54481
Non-Certified School Setting(s) Setting Begin/End Dates PBHS KEWAUNEE HIGH SCHOOL, 911 3RD STREET, KEWAUNEE, WI 54216 11/01/2020 10/31/2022 PBHS LIGHTHOUSE LEARNING ACADEMY, 4521 LINCOLN AVE, TWO RIVERS, WI 54241 11/01/2020 10/31/2022
09/28/2021 Page 96 of 222 Mental Health Program Directory By County, City, and Provider Name
MARATHON MARSHFIELD CHILD & ADOLESCENT PSYCHIATRY CONSULTING DBA EMPOWER MENTAL HEALTH CLINIC 2981
2001 S CENTRAL AVE, STE A-B GENESSA ANTONIEWICZ Initial Cert: 09/27/2012 MARSHFIELD, WI 54449 [email protected] Cert Eff: 01/01/2021 County: Marathon Phone:(715) 384-2818 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (715) 384-2724
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 3 ABBOTSFORD ELEMENTARY SCHOOL, 510 W HEMLOCK STREET, ABBOTSFORD, WI 54405 01/01/2021 08/31/2022 3 COLBY ELEMENTARY SCHOOL, 202 WEST DOLF STREET PO BOX 80, COLBY, WI 54421 01/01/2021 08/31/2022 3 COLBY HIGH SCHOOL, 703 N 2ND STREET, COLBY, WI 54421 01/01/2021 08/31/2022 3 ALEXANDER MIDDLE SCHOOL, 540 BIRCH STREET, NEKOOSA, WI 54457 01/01/2021 08/31/2022 3 HUMKE ELEMENTARY, 500 S. SECTION STREET, NEKOOSA, WI 54457 01/01/2021 08/31/2022 3 NEKOOSA HIGH SCHOOL, 500 CEDAR ST, NEKOOSA, WI 54457 01/01/2021 08/31/2022 3 PITTSVILLE ELEMENTARY SCHOOL, 5459 ELEMENTARY AVE #1, PITTSVILLE, WI 54466 01/01/2021 08/31/2022 3 PITTSVILLE HIGH SCHOOL, 5407 1ST AVENUE, PITTSVILLE, WI 54466 01/01/2021 08/31/2022
GATEWAYS COUNSELING SERVICES LLC 3217
1905 S CENTRAL AVE MICHELLE MESSICK Initial Cert: 07/05/2018 MARSHFIELD, WI 54449 [email protected] Cert Eff: 08/01/2021 County: Marathon Phone:(715) 898-1665 Cert Exp: 07/31/2023 Surveyor: Roderick Senn Fax: (715) 898-1240
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2021 07/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 GATEWAYS COUNSELING SERVICES, 125 FILLMORE STREET, BLACK RIVER FALLS, WI 54615 08/01/2021 07/31/2023 2 GATEWAYS COUNSELING SERVICES, 510 W 5TH STREET, NEILLSVILLE, WI 54456 08/01/2021 07/31/2023
WAUSAU ACHIEVE CENTER 2719
520 NORTH 28TH AVE, #200 CAROL WESLEY Initial Cert: 04/01/2007 WAUSAU, WI 54401 [email protected] Cert Eff: 07/01/2020 County: Marathon Phone:(715) 845-4900 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (715) 845-4970
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ROSHOLT K-12 SCHOOL, 346 W RANDOLPH ST, ROSHOLT, WI 54473 07/01/2020 03/31/2022 DC EVEREST HIGH SCHOOL, 6500 ALDERSON ST, SCHOFIELD, WI 54476 07/01/2020 03/31/2022 DC EVEREST JUNIOR HIGH, 1000 MACHMUELLER ST, SCHOFIELD, WI 54476 07/01/2020 03/31/2022 HORACE MANN MIDDLE SCHOOL, 3101 NORTH 13TH ST, WAUSAU, WI 54403 07/01/2020 03/31/2022 ODYSSEY ELEMENTARY SCHOOL, 4704 CAMP PHILLIPS RD, WESTON, WI 54476 07/01/2020 03/31/2022
09/28/2021 Page 97 of 222 Mental Health Program Directory By County, City, and Provider Name
ACS CLINICAL SERVICES, LLC 2873
618 JACKSON STREET SHAWN YEAGER Initial Cert: 09/15/2009 WAUSAU, WI 54403 [email protected] Cert Eff: 10/01/2021 County: Marathon Phone:(715) 848-3202 Cert Exp: 09/30/2023 Surveyor: Renee DeWitt Fax: (715) 355-0667
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2021 09/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
CENTER FOR HUMAN DEVELOPMENT 1153
631 FOREST STREET LEE WEBSTER Initial Cert: 12/01/1996 WAUSAU, WI 54403 [email protected] Cert Eff: 12/01/2019 County: Marathon Phone:(715) 842-0944 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (715) 845-6477
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 CENTER FOR HUMAN DEVELOPMENT, 1105 E MAIN ST, MERRILL, WI 54452 04/15/2020 11/30/2021 1 CENTER FOR HUMAN DEVELOPMENT INC, 1509 N FOURTH ST, SUITE 2, TOMAHAWK, WI 54487 12/01/2019 11/30/2021
3 ATHENS GRADE SCHOOL, 209 SCHLEGEL ST, ATHENS, WI 54411 12/04/2019 11/30/2021 3 ATHENS MIDDLE/HIGH SCHOOL, 601 W LIMIT RD, ATHENS, WI 54411 12/01/2019 11/30/2021 3 JEFFERSON ELEMENTARY SCHOOL, 1914 W JACKSON ST, MERRILL, WI 54452 12/01/2019 11/30/2021 3 KATE GOODRICH ELEMENTARY SCHOOL, 505 W 10TH ST, MERRILL, WI 54452 12/01/2019 11/30/2021 3 MERRILL HIGH SCHOOL, 1201 NORTH SALES STREET, MERRILL, WI 54452 12/01/2019 11/30/2021 3 PRAIRIE RIVER MIDDLE SCHOOL, 106 POLK STREET, MERRILL, WI 54452 12/01/2019 11/30/2021 3 TOMAHAWK K-12, 1048 E KING RD, TOMAHAWK, WI 54487 12/01/2019 11/30/2021
CHARIS COUNSELING, LLC 2464
2620 W. STEWART AVENUE, #310 LORI THOMPSON Initial Cert: 09/01/2003 WAUSAU, WI 54401 [email protected] Cert Eff: 09/01/2020 County: Marathon Phone:(715) 848-0525 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (715) 848-8665
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CHARIS COUNSELING, LLC, 101 W MC MILLAN STREET, #2B, MARSHFIELD, WI 54449 09/01/2020 08/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates THOMAS JEFFERSON ELEMENTARY SCHOOL, 500 RANDOLPH ST, WAUSAU, WI 54401 09/01/2020 08/31/2022
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CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1185
705 S. 24TH AVENUE, #400 ANNE LACHAPELLE Initial Cert: 12/01/1983 WAUSAU, WI 54401 [email protected] Cert Eff: 01/01/2020 County: Marathon Phone:(715) 848-1457 Cert Exp: 12/31/2021 Surveyor: Renee DeWitt Fax: (715) 848-2959
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 CHILDREN'S SERVICE SOCIETY OF WI - MARSHFIELD, 725 S CENTRAL AVE, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 2 CHILDREN'S SERVICE SOCIETY OF WI-STEVENS PT, 1466 WATER STREET, STEVENS POINT, WI 01/01/2020 12/31/2021 54481
Non-Certified School Setting(s) Setting Begin/End Dates COLUMBUS CATHOLIC HIGH SCHOOL, 710 S COLUMBUS AVE, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 COLUMBUS CATHOLIC MIDDLE SCHOOL, 710 S COLUMBUS AVE, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 GRANT ELEMENTARY SCHOOL, 425 W UPHAM ST, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 LINCOLN ELEMENTARY SCHOOL, 1621 S FELKER AVE, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 MARSHFIELD HIGH SCHOOL, 1401 E BECKER ROAD, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 MARSHFIELD MIDDLE SCHOOL, 900 E 4TH ST, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 NASONVILLE ELEMENTARY SCHOOL, 11044 US HIGHWAY 10, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 OUR LADY OF PEACE INTERMEDIATE SCHOOL, 1300 W 5TH ST, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 WASHINGTON ELEMENTARY SCHOOL, 1112 W 11TH ST, MARSHFIELD, WI 54449 01/01/2020 12/31/2021 NEILLSVILLE ELEMENTARY SCHOOL, 504 E FIFTH STREET, NEILLSVILLE, WI 54456 01/01/2020 12/31/2021 NEILLSVILLE HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456 01/01/2020 12/31/2021 BLISS EDUCATIONAL SERVICES CENTER, 1900 POLK ST, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 CHARLES F FERNANDEZ CENTER, 1025 CLARK STREET, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 JEFFERSON ELEMENTARY, 1800 EAST AVE, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 MADISON ELEMENTARY, 600 MARIA DRIVE, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 MCDILL ELEMENTARY, 2516 SCHOOL STREET, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 MCKINLEY ELEMENTARY, 2926 BLAINE STREET, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 TOMAHAWK ELEMENTARY SCHOOL, 1048 E KING RD, TOMAHAWK, WI 54487 01/01/2020 12/31/2021 GRANT ELEMENTARY SCHOOL, 500 N 4TH AVE, WAUSAU, WI 54401 01/01/2020 12/31/2021 LINCOLN ELEMENTARY SCHOOL, 720 S 6TH AVE, WAUSAU, WI 54401 01/01/2020 12/31/2021 RIB MOUNTAIN ELEMENTARY SCHOOL, 2701 ROBIN LANE, WAUSAU, WI 54401 01/01/2020 12/31/2021
DIX & GILLETTE COUNSELING SERVICES, LLP 2349
1720 MERRILL AVE SUITE 401 NORAH BROWN Initial Cert: 02/01/2001 WAUSAU, WI 54401 [email protected] Cert Eff: 02/01/2020 County: Marathon Phone:(715) 675-3888 Cert Exp: 01/31/2022 Surveyor: Renee DeWitt Fax: (715) 675-2988
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2020 01/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 99 of 222 Mental Health Program Directory By County, City, and Provider Name
ELMERGREEN ASSOCIATES, INC. 1299
114 GRAND AVENUE DENNIS ELMERGREEN Initial Cert: 11/05/1992 WAUSAU, WI 54403 [email protected] Cert Eff: 11/01/2019 County: Marathon Phone:(715) 845-7175 Cert Exp: 10/31/2021 Surveyor: Renee DeWitt Fax: (715) 845-7142
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 ELMERGREEN ASSOCIATES, 239 ROSS AVE, SUITE 304, SCHOFIELD, WI 54476 01/05/2021 10/31/2021
NORTH CENTRAL HEALTH CARE 1677
1100 LAKE VIEW DRIVE MICHAEL LOY Initial Cert: 10/01/1975 WAUSAU, WI 54403 [email protected] Cert Eff: 03/01/2021 County: Marathon Phone:(715) 848-4600 Cert Exp: 02/28/2023 Surveyor: Renee DeWitt Fax: (715) 848-2362 Crisis Intervention Services Regional Designation Begin End Lead DHS 51.42 MULTI-COUNTY PROGRAM: LANGLADE, LINCOLN, MARATHON 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-AMBULATORY DETOXIFICATION DHS 75.08 03/01/2021 03/24/2021 CSAS-DAY TREATMENT DHS 75.12 03/01/2021 02/28/2023 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2021 02/28/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 03/01/2021 02/28/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2021 02/28/2023 MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 2 ANTIGO CENTER, 1225 LANGLADE ROAD, ANTIGO, WI 54409 03/01/2021 02/28/2023 2 MERRILL CENTER, 607 N SALES STREET, #309, MERRILL, WI 54452 03/01/2021 02/28/2023
Non-Certified School Setting(s) Setting Begin/End Dates MOSINEE ELEMENTARY SCHOOL, 600 12TH STREET, MOSINEE, WI 54455 03/01/2021 02/28/2023 MOSINEE HIGH SCHOOL, 1000 HIGH STREET, MOSINEE, WI 54455 03/01/2021 02/28/2023 MOSINEE MIDDLE SCHOOL, 700 HIGH STREET, MOSINEE, WI 54455 03/01/2021 02/28/2023 DC EVEREST SENIOR HIGH, 6500 ALDERSON STREET, SCHOFIELD, WI 54476 03/01/2021 02/28/2023
NORTH CENTRAL HEALTH CARE 3303
2380 MARSHALL STREET TRISHA STEFONEK Initial Cert: 09/22/2020 WAUSAU, WI 54403 [email protected] Cert Eff: 09/22/2020 County: Marathon Phone:(715) 848-4600 Cert Exp: 09/30/2021 Surveyor: Renee DeWitt Fax: (715) 841-5189
Services Adm Code Service Begin/End Dates MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 09/22/2020 09/30/2021 NO BRANCH LOCATIONS
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NORTH CENTRAL HEALTH CARE CCS 3041
1100 LAKE VIEW DRIVE JANELLE HINTZ Initial Cert: 07/01/2014 WAUSAU, WI 54403 [email protected] Cert Eff: 01/01/2020 County: Marathon Phone:(715) 848-4322 Cert Exp: 12/31/2021 Surveyor: Renee DeWitt Fax: (715) 841-5146
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL UNIFIED BOARD DHS 36 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 1225 LANGLADE ROAD, ANTIGO, WI 54409 01/01/2020 12/31/2021 2 NORTH CENTRAL HEALTH CARE - LINCOLN COUNTY, 607 N SALES ST STE 309, MERRILL, WI 54452 01/01/2020 12/31/2021
NORTH CENTRAL HEALTH CARE CSP 2297
1100 LAKE VIEW DRIVE JANELLE HINTZ Initial Cert: 10/01/1975 WAUSAU, WI 54403 [email protected] Cert Eff: 01/01/2020 County: Marathon Phone:(715) 848-4322 Cert Exp: 12/31/2021 Surveyor: Renee DeWitt Fax: (715) 841-5146
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 NORTH CENTRAL HEALTH CARE CSP - LANGLADE, 1225 LANGLADE ROAD, ANTIGO, WI 54409 01/01/2020 12/31/2021 2 NORTH CENTRAL HEALTH CARE CSP - LINCOLN, 607 N SALES ST STE 309, MERRILL, WI 54452 01/01/2020 12/31/2021
NORTH CENTRAL HEALTH CARE YOURTH CRISIS STABILIZATION PROGRAM 3320
2370 MARSHALL ST ERICA HUFFMAN Initial Cert: 06/15/2021 WAUSAU, WI 54403 [email protected] Cert Eff: 09/09/2021 County: Marathon Phone:(715) 848-4310 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (715) 843-6123
Services Adm Code Service Begin/End Dates MENTAL HEALTH YOUTH CRISIS STABILIZATION FACILITY DHS 50 09/09/2021 08/31/2023 NO BRANCH LOCATIONS
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - WAUSAU 2404
5655 N 28TH AVE JACKIE MAURER Initial Cert: 09/18/2002 WAUSAU, WI 54401 [email protected] Cert Eff: 02/01/2021 County: Marathon Phone:(715) 675-5454 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (888) 226-8713
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 101 of 222 Mental Health Program Directory By County, City, and Provider Name
PEACEFUL SOLUTIONS COUNSELING 2715
731 NORTH 1ST STREET MICHELLE GLEASON Initial Cert: 03/01/2007 WAUSAU, WI 54403 [email protected] Cert Eff: 03/01/2020 County: Marathon Phone:(715) 675-3458 Cert Exp: 02/28/2022 Surveyor: Renee DeWitt Fax: (715) 675-7238
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 1 PEACEFUL SOLUTIONS COUNSELING, 726 EAST 2ND STREET, MERRILL, WI 54452 03/01/2020 02/28/2022
3 EDGAR PUBLIC SCHOOL, 203 E BIRCH ST, EDGAR, WI 54426 03/01/2020 02/28/2022 3 WAUSAU EAST HIGH SCHOOL, 2607 NORTH 18TH STREET, WAUSAU, WI 54403 03/01/2020 02/28/2022
PRIMARY CONNECTION HEALTH CARE, INC. DBA BRIDGE COMMUNITY HEALTH CLINIC 2879
1810 N SECOND STREET DAKOTA KAISER Initial Cert: 08/01/2009 WAUSAU, WI 54403 [email protected] Cert Eff: 01/01/2021 County: Marathon Phone:(715) 848-4884 Cert Exp: 07/31/2022 Surveyor: Renee DeWitt Fax: (715) 845-5385
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 07/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates JOHN MUIR MIDDLE SCHOOL, 1400 W STEWART AVE, WAUSAU, WI 54401 01/01/2021 07/31/2022 WAUSAU ALTERNATIVE HIGH SCHOOL, 2520 N 14TH AVE, WAUSAU, WI 54401 01/01/2021 07/31/2022 WAUSAU EAST HIGH SCHOOL / EEA, 2607 N 18TH ST, WAUSAU, WI 54403 01/01/2021 07/31/2022 WAUSAU WEST HIGH SCHOOL, 1200 W WAUSAU AVE, WAUSAU, WI 54401 01/01/2021 07/31/2022
THE CARING TREE - CHILDREN'S COUNSELING CENTER 3179
227400 RIB MOUNTAIN DRIVE, STE D TRENA LOOMANS Initial Cert: 08/04/2017 WAUSAU, WI 54401 [email protected] Cert Eff: 01/01/2021 County: Marathon Phone:(715) 301-0667 Cert Exp: 07/31/2022 Surveyor: Renee DeWitt Fax: (715) 870-2267
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 07/31/2022 NO BRANCH LOCATIONS
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THE CENTRE FOR WELL-BEING INC. 1909
901 N 6TH STREET NOREEN SALZMAN Initial Cert: 02/17/1992 WAUSAU, WI 54403 [email protected] Cert Eff: 09/01/2021 County: Marathon Phone:(715) 848-5022 Cert Exp: 08/31/2023 Surveyor: Renee DeWitt Fax: (888) 778-6750
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 THE CENTRE FOR WELL-BEING, 607 CEDAR AVE, MERRILL, WI 54452 09/01/2021 08/31/2023 2 THE CENTRE FOR WELL-BEING, 310A N BROWN ST, RHINELANDER, WI 54501 09/01/2021 08/31/2023 2 THE CENTRE FOR WELL-BEING, 4601 CAMP PHILLIPS RD, WESTON, WI 54476 09/01/2021 08/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates EVERGREEN ELEMENTARY, 1610 PINE RD, ROTHSCHILD, WI 54474 09/01/2021 08/31/2023 FRANKLIN ELEMENTARY, 1509 N 5TH ST, WAUSAU, WI 54403 09/01/2021 08/31/2023 HORACE MANN MIDDLE SCHOOL, 3101 N 13TH ST, WAUSAU, WI 54403 09/01/2021 08/31/2023 JOHN MUIR MIDDLE SCHOOL, 1400 W STEWART AVE, WAUSAU, WI 54401 09/01/2021 08/31/2023 LINCOLN ELEMENTARY, 720 S 6TH AVE, WAUSAU, WI 54401 09/01/2021 08/31/2023 WAUSAU WEST HIGH SCHOOL, 1200 W WAUSAU AVE, WAUSAU, WI 54401 09/01/2021 08/31/2023
WESTON ASPIRUS BEHAVIORAL MEDICINE CLINIC 2752
4005 COMMUNITY CENTER DRIVE NICKI WILLIAMS Initial Cert: 03/01/2007 WESTON, WI 54476 [email protected] Cert Eff: 03/01/2021 County: Marathon Phone:(715) 241-5400 Cert Exp: 02/28/2023 Surveyor: Renee DeWitt Fax: (715) 241-5448
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ASPIRUS ANTIGO CLINIC, 112 EAST 5TH AVE, ANTIGO, WI 54409 03/01/2021 02/28/2023 1 ASPIRUS HOUGHTON CLINIC, 1000 CEDAR ST, HOUGHTON, MI 49931 03/01/2021 02/28/2023 1 ASPIRUS MEDFORD CLINIC, 143 S GIBSON ST, MEDFORD, WI 54451 03/01/2021 02/28/2023 1 ASPIRUS WAUSAU FAMILY CLINIC, 425 WINDRIDGE DR, WAUSAU, WI 54401 03/01/2021 02/28/2023 1 ASPIRUS WESTON CLINIC - WI RAPIDS OUTREACH, 410 DEWEY ST, WISCONSIN RAPIDS, WI 54494 03/01/2021 02/28/2023
2 ASPIRUS RHINELANDER OUTREACH, 1630 N CHIPPEWA DR, RHINELANDER, WI 54501 03/01/2021 02/28/2023
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COMPASS COUNSELING WAUSAU, LLC 2939
3704 WESTON AVE TRACY PETERSON Initial Cert: 03/25/2011 WESTON, WI 54476 [email protected] Cert Eff: 04/01/2020 County: Marathon Phone:(715) 298-6364 Cert Exp: 03/31/2022 Surveyor: Renee DeWitt Fax: (715) 298-6365
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
Tier Branch Location(s) Branch Begin/End Dates 2 COMPASS COUNSELING, 718 GRAND AVE, SCHOFIELD, WI 54476 04/01/2020 03/31/2022 2 COMPASS COUNSELING WAUSAU, LLC, 530 GRANT ST, WAUSAU, WI 54403 04/01/2020 03/31/2022 2 COMPASS COUNSELING WAUSAU, LLC, 1210 PARKWOOD DR, WISCONSIN RAPIDS, WI 54494 06/01/2021 03/31/2022
3 TOMORROW RIVER, 357 N MAIN ST, AMHERST, WI 54406 04/01/2020 03/31/2022 3 PORT EDWARDS ELEMENTARY, 951 5TH ST, PORT EDWARDS, WI 54469 04/01/2020 03/31/2022 3 PORT EDWARDS HIGH/MIDDLE, 801 2ND ST, PORT EDWARDS, WI 54469 04/01/2020 03/31/2022 3 ROTHSCHILD ELEMENTARY SCHOOL, 801 1ST ST, ROTHSCHILD, WI 54474 04/01/2020 03/31/2022
09/28/2021 Page 104 of 222 Mental Health Program Directory By County, City, and Provider Name
MARINETTE MARINETTE MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT / ADAPT 1559
2500 HALL AVENUE MELISSA FREEMAN Initial Cert: 01/01/1982 MARINETTE, WI 54143 [email protected] Cert Eff: 12/01/2019 County: Marinette Phone:(715) 732-7760 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (715) 732-7711 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 CRISIS DIVERSION FACILITIES SHARED SERVICES 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 12/01/2019 11/30/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 2 MARINETTE COUNTY HHSD/ADAPT, 1201 JACKSON STREET, NIAGARA, WI 54151 12/01/2019 11/30/2021
MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT CSP 2340
2500 HALL AVENUE, #A CANDACE BREAULT Initial Cert: 01/01/1982 MARINETTE, WI 54143 [email protected] Cert Eff: 12/01/2019 County: Marinette Phone:(715) 732-7760 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (715) 732-7766
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
MARINETTE, OCONTO AND MENOMINEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM 3074
2500 HALL AVE MEGAN KELLER Initial Cert: 10/01/2015 MARINETTE, WI 54143 [email protected] Cert Eff: 01/01/2021 County: Marinette Phone:(715) 732-7700 Cert Exp: 09/30/2022 Surveyor: Renee DeWitt Fax: (715) 732-7711
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 01/01/2021 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 MENOMINEE COUNTY HHS, W3272 WOLF RIVER DRIVE, KESHENA, WI 54135 01/01/2021 09/30/2022
2 OCONTO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 501 PARK AVE, OCONTO, WI 54153 01/01/2021 09/30/2022
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MARQUETTE MONTELLO MARQUETTE COUNTY HUMAN SERVICES 1560
480 UNDERWOOD AVE DAWN WOODARD Initial Cert: 03/01/1981 MONTELLO, WI 53949 [email protected] Cert Eff: 08/01/2020 County: Marquette Phone:(608) 297-3181 Cert Exp: 04/30/2022 Surveyor: Heather Lom Fax: (608) 297-2148 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 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 08/01/2020 04/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 04/30/2022 CSAS-PREVENTION DHS 75.04 08/01/2020 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 04/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 08/01/2020 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 MONTELLO SCHOOLS, 222 FOREST LANE, MONTELLO, WI 53949 08/01/2020 04/30/2022 3 WESTFIELD ELEMENTARY SCHOOL, 329 HAWK LANE, WESTFIELD, WI 53964 08/01/2020 04/30/2022 3 WESTFIELD MIDDLE/HIGH SCHOOL, N7046 COUNTY ROAD M, WESTFIELD, WI 53964 08/01/2020 04/30/2022
MARQUETTE COUNTY HUMAN SERVICES - CCS 3108
480 UNDERWOOD AVE DAWN WOODARD Initial Cert: 01/01/2016 MONTELLO, WI 53949 [email protected] Cert Eff: 01/01/2021 County: Marquette Phone:(608) 297-3181 Cert Exp: 12/31/2022 Surveyor: Heather Lom Fax: (608) 297-2148
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 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
MARQUETTE COUNTY HUMAN SERVICES - CSP 3125
480 UNDERWOOD AVE DAWN WOODARD Initial Cert: 03/28/2016 MONTELLO, WI 53949 [email protected] Cert Eff: 03/01/2021 County: Marquette Phone:(608) 297-3124 Cert Exp: 02/28/2023 Surveyor: Heather Lom Fax: (608) 297-2148
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
09/28/2021 Page 106 of 222 Mental Health Program Directory By County, City, and Provider Name
WESTFIELD NORTHLAND COMMUNITY SERVICES 1693
161 SPRING STREET DR JON MATTHEW Initial Cert: 01/01/1983 WESTFIELD, WI 53964 [email protected] Cert Eff: 11/01/2020 County: Marquette Phone:(608) 296-2139 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (608) 296-1590
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NORTHLAND COMMUNITY SERVICES, 139 S MAIN, PO BOX 1178, ADAMS, WI 53910 11/01/2020 10/31/2022
09/28/2021 Page 107 of 222 Mental Health Program Directory By County, City, and Provider Name
MENOMINEE KESHENA MENOMINEE COUNTY HUMAN SERVICES 1587
W3272 WOLF RIVER ROAD SHANNON WILBER Initial Cert: 11/01/1994 KESHENA, WI 54135 [email protected] Cert Eff: 05/01/2021 County: Menominee Phone:(715) 799-3861 Cert Exp: 04/30/2023 Surveyor: Renee DeWitt Fax: (715) 799-3517 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 05/01/2021 04/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
MENOMINEE COUNTY HUMAN SERVICES CSP 2228
W3272 WOLF RIVER ROAD LIZ MALCHOW Initial Cert: 11/01/1994 KESHENA, WI 54135 [email protected] Cert Eff: 05/01/2021 County: Menominee Phone:(715) 799-3861 Cert Exp: 04/30/2023 Surveyor: Renee DeWitt Fax: (715) 799-3517
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
MENOMINEE TRIBAL CLINIC, BEHAVIORAL HEALTH SERVICES 1588
W3275 WOLF RIVER DRIVE JODI OPPER Initial Cert: 03/03/1993 KESHENA, WI 54135 [email protected] Cert Eff: 03/01/2021 County: Menominee Phone:(715) 799-5451 Cert Exp: 02/28/2023 Surveyor: Renee DeWitt Fax: (715) 799-3929
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
09/28/2021 Page 108 of 222 Mental Health Program Directory By County, City, and Provider Name
MILWAUKEE BROWN DEER AMERICAN RELAXATION COUNSELING SERVICE, LLC 3255
5600 W BROWN DEER RD STE 106 RAPHAEL FORD Initial Cert: 06/01/2019 BROWN DEER, WI 53223 [email protected] Cert Eff: 09/01/2020 County: Milwaukee Phone:(414) 446-8154 Cert Exp: 05/31/2022 Surveyor: Kelley Clark Fax: () -
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022 NO BRANCH LOCATIONS
REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC 2882
4550 W BRADLEY ROAD ROGER PUMPHREY Initial Cert: 09/01/2009 BROWN DEER, WI 53223 [email protected] Cert Eff: 09/01/2020 County: Milwaukee Phone:(414) 371-1600 Cert Exp: 08/31/2022 Surveyor: Connie Knezic Fax: (414) 371-1400
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 08/31/2022 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT 2532
4555 W SCHROEDER DRIVE MAEVE O'NEILL Initial Cert: 07/13/2004 BROWN DEER, WI 53223 [email protected] Cert Eff: 07/01/2021 County: Milwaukee Phone:(414) 355-9000 Cert Exp: 06/30/2023 Surveyor: Kelley Clark Fax: (414) 355-9665
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 07/01/2021 06/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL, INC 3084
4600 WEST SCHROEDER DRIVE MAEVE O'NEILL Initial Cert: 04/28/2015 BROWN DEER, WI 53223 [email protected] Cert Eff: 07/01/2020 County: Milwaukee Phone:(414) 865-2500 Cert Exp: 03/31/2022 Surveyor: Connie Knezic Fax: (414) 797-0804
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2020 03/31/2022 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 07/01/2020 03/31/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 07/01/2020 03/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2020 03/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 109 of 222 Mental Health Program Directory By County, City, and Provider Name
CUDAHY AURORA HEALTH CARE METRO, INC. DBA AURORA ST. LUKE'S SOUTH SHORE 1867
5900 S. LAKE DRIVE JAMIE SURFUS-LEWISTON Initial Cert: 11/01/1989 CUDAHY, WI 53110 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 489-4125 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (414) 489-4056
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2020 09/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2020 09/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2020 09/30/2022 NO BRANCH LOCATIONS GLENDALE AURORA BEHAVIORAL HEALTH NORTH SHORE 1335
6980 N PORT WASHINGTON #202 CARRIE SLOMSKI Initial Cert: 08/01/1985 GLENDALE, WI 53217 [email protected] Cert Eff: 08/01/2020 County: Milwaukee Phone:(414) 454-6454 Cert Exp: 07/31/2022 Surveyor: Kelley Clark Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA BEHAVIORAL HEALTH - GRAFTON, 975 N. PORT WASHINGTON RD, GRAFTON, WI 53024 08/01/2020 07/31/2022 2 AURORA BEHAVIORAL HEALTH - PORT WASHINGTON, 1777 W GRAND AVE, PORT WASHINGTON, WI 08/01/2020 07/31/2022 53074
AURORA PSYCHIATRIC HOSPITAL INC 3155
6980 N PORT WASHINGTON ROAD TODD SCHROLL Initial Cert: 09/29/2016 GLENDALE, WI 53217 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 454-6601 Cert Exp: 08/31/2023 Surveyor: Connie Knezic Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
LA CAUSA, INC. 2367
5235 N IRONWOOD ROAD LAKESHA JONES Initial Cert: 04/22/2002 GLENDALE, WI 53209 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 902-1526 Cert Exp: 04/30/2023 Surveyor: Kelley Clark Fax: (414) 771-7491
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 110 of 222 Mental Health Program Directory By County, City, and Provider Name
NORTH SHORE PSYCHOTHERAPY ASSOCIATES 1683
5555 N PORT WASHINGTON RD THERESA HANAMAN Initial Cert: 07/01/1980 GLENDALE, WI 53217 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 962-6764 Cert Exp: 09/30/2022 Surveyor: Kelley Clark Fax: (414) 962-6765
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
SHOREHAVEN BEHAVIORAL HEALTH INC 1836
3900 W BROWN DEER ROAD #200 LYNN GODEC Initial Cert: 07/01/1983 GLENDALE, WI 53209 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 540-2170 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (414) 540-2171
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 SHOREHAVEN BEHAVIORAL HEALTH INC, 4370 SOUTH 76TH STREET, GREENFIELD, WI 53220 04/01/2021 09/30/2022 2 SHOREHAVEN BEHAVIORAL HEALTH, INC., 6233 DURAND AVE #F, RACINE, WI 53406 04/01/2021 09/30/2022
STRESS MANAGEMENT & MENTAL HEALTH CLINICS 3203
5225 N IRONWOOD RD #102 GREG BUSHMAN Initial Cert: 04/01/2018 GLENDALE, WI 53217 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 962-9156 Cert Exp: 03/31/2023 Surveyor: Connie Knezic Fax: (414) 962-4356
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS MILWAUKEE 4TH DIMENSION RECOVERY CENTERS 3229
1216 N PROSPECT AVE PAMELA BLASZAK Initial Cert: 10/11/2018 MILWAUKEE, WI 53202 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 406-7852 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (414) 455-8781
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2020 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 111 of 222 Mental Health Program Directory By County, City, and Provider Name
ACCESS RECOVERY MENTAL HEALTH SERVICES (ARMHS) 3119
2727 WEST CLEVELAND AVE, #204 MOHAMED YAROW Initial Cert: 03/10/2016 MILWAUKEE, WI 53215 [email protected] Cert Eff: 03/01/2020 County: Milwaukee Phone:(414) 269-8356 Cert Exp: 02/28/2022 Surveyor: Connie Knezic Fax: (414) 455-1915
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 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 NO BRANCH LOCATIONS
ADKINS COUNSELING SERVICES 2844
6001 W CENTER STREET #105 MARCELLA ADKINS Initial Cert: 01/22/2009 MILWAUKEE, WI 53210 [email protected] Cert Eff: 01/01/2020 County: Milwaukee Phone:(414) 393-1099 Cert Exp: 12/31/2021 Surveyor: Connie Knezic Fax: (414) 393-9773
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
AMRI COUNSELING SERVICES, LLC 2875
4001 WEST CAPITOL DRIVE LAKEIA JONES Initial Cert: 08/01/2009 MILWAUKEE, WI 53216 [email protected] Cert Eff: 08/01/2020 County: Milwaukee Phone:(414) 810-6691 Cert Exp: 07/31/2022 Surveyor: Connie Knezic Fax: (866) 719-3024
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2020 07/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 AMRI COUNSELING SERVICES, 6321 23RD AVENUE, KENOSHA, WI 53143 08/01/2020 07/31/2022 1 AMRI COUNSELING SERVICES, 3536 W FOND DU LAC AVE, MILWAUKEE, WI 53216 08/01/2020 07/31/2022
3 MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN AVE, MILWAUKEE, WI 53233 08/01/2020 07/31/2022
ANGELS COUNSELING & THERAPY SERVICE 2874
8515 B WEST HAMPTON AVENUE AUGUSTINA GARBA Initial Cert: 08/01/2009 MILWAUKEE, WI 53225 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 630-0102 Cert Exp: 07/31/2023 Surveyor: Connie Knezic Fax: (414) 455-8362
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 112 of 222 Mental Health Program Directory By County, City, and Provider Name
ASAP - BEHAVIORAL HEALTH 3263
11380 W THEODORE TRECKER WAY VERNON PARTELLO Initial Cert: 12/20/2019 MILWAUKEE, WI 53214 [email protected] Cert Eff: 12/20/2020 County: Milwaukee Phone:(414) 310-9685 Cert Exp: 12/19/2022 Surveyor: Connie Knezic Fax: (414) 775-7572
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/20/2020 12/19/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/20/2020 12/19/2022 NO BRANCH LOCATIONS
ASCENSION COLUMBIA ST MARYS MILWAUKEE INPATIENT BEHAVIORAL HEALTH 1215
2301 N LAKE DR BENJAMIN PEERBOLT Initial Cert: 07/01/2015 MILWAUKEE, WI 53211 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 585-5530 Cert Exp: 06/30/2022 Surveyor: Kelley Clark Fax: (414) 585-1924
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2020 06/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
ASCENSION COLUMBIA ST MARYS MILWAUKEE OUTPATIENT BEHAVIORAL HEALTH 1870
2323 N LAKE DRIVE BENJAMIN PEERBOLT Initial Cert: 06/01/1981 MILWAUKEE, WI 53211 [email protected] Cert Eff: 01/01/2020 County: Milwaukee Phone:(414) 585-1620 Cert Exp: 12/31/2021 Surveyor: Kelley Clark Fax: (414) 585-1924
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 01/01/2020 12/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
ASCENSION SE WI HOSPITAL, INC ST JOSEPH BEHAVIORAL HEALTH 2548
5000 W CHAMBERS ST #P210 CAROL HESS Initial Cert: 10/27/2004 MILWAUKEE, WI 53210 [email protected] Cert Eff: 11/01/2019 County: Milwaukee Phone:(414) 874-1171 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 874-1177
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 113 of 222 Mental Health Program Directory By County, City, and Provider Name
ASCENSION ST FRANCIS HOSPITAL, INC BEHAVIORAL HEALTH 2547
3237 S 16TH STREET #310 CAROL HESS Initial Cert: 10/27/2004 MILWAUKEE, WI 53215 [email protected] Cert Eff: 11/01/2019 County: Milwaukee Phone:(414) 389-3111 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 389-3110
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2019 10/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 ASCENSION FRANKLIN MOB, 9969 S 27TH STREET, FRANKLIN, WI 53132 11/01/2019 10/31/2021 1 ASCENSION COLUMBIA ST MARYS AIRPORT, 4848 S 6TH ST, MILWAUKEE, WI 53221 11/01/2019 10/31/2021
AURORA BEHAVIORAL HEALTH CENTER - SINAI 1839
1020 N 12TH ST, 401 TANYA WASHINGTON Initial Cert: 10/01/1987 MILWAUKEE, WI 53233 [email protected] Cert Eff: 01/01/2020 County: Milwaukee Phone:(708) 441-1154 Cert Exp: 12/31/2021 Surveyor: Kelley Clark Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
AURORA FAMILY SERVICE, INC. 1336
1020 N 12TH STREET, STE #200 ROBERT MARRS Initial Cert: 05/01/1977 MILWAUKEE, WI 53233 [email protected] Cert Eff: 05/10/2021 County: Milwaukee Phone:(414) 342-4560 Cert Exp: 07/31/2022 Surveyor: Connie Knezic Fax: (414) 219-4860
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/10/2021 07/31/2022 NO BRANCH LOCATIONS
BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM 2456
1849 MARTIN LUTHER KING DRIVE NOCHIA PERRY Initial Cert: 01/15/2003 MILWAUKEE, WI 53212 [email protected] Cert Eff: 01/01/2020 County: Milwaukee Phone:(414) 347-1774 Cert Exp: 12/31/2021 Surveyor: Kelley Clark Fax: (414) 347-0148
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 114 of 222 Mental Health Program Directory By County, City, and Provider Name
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. 1132
2021 N. 60TH STREET RICARDO CISNEROS Initial Cert: 06/01/1981 MILWAUKEE, WI 53208 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 771-2881 Cert Exp: 04/30/2023 Surveyor: Kelley Clark Fax: (414) 771-1674
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
CHILD, ADOLESCENT, FAMILY & MARRIAGE THERAPY ASSOCIATES 1177
161 W WISCONSIN AVE, STE 5190 SUSAN WILLIAMS PEPPER-SIM Initial Cert: 03/01/1995 MILWAUKEE, WI 53203 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 272-5005 Cert Exp: 03/31/2023 Surveyor: Connie Knezic Fax: (414) 272-3760
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
CHILDREN'S HOSPITAL OF MILWAUKEE 2417
619 W WALNUT STREET ANDREA CARROLL Initial Cert: 01/22/2003 MILWAUKEE, WI 53212 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 266-2932 Cert Exp: 12/31/2022 Surveyor: Kelley Clark Fax: (414) 266-3735
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
CHILDREN'S HOSPITAL OF WISCONSIN 1179
9000 W. WISCONSIN AVENUE AMY RIDLEY MEYERS Initial Cert: 10/01/1978 MILWAUKEE, WI 53226 [email protected] Cert Eff: 12/01/2020 County: Milwaukee Phone:(414) 266-2932 Cert Exp: 11/30/2022 Surveyor: Connie Knezic Fax: (414) 266-3735
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CHILDREN'S HOSP OF WI CLINICS - MEQUON, 1655 W MEQUON RD, MEQUON, WI 53092 12/01/2020 11/30/2022 2 CHILDREN'S HOSP OF WI CLINICS-NEW BERLIN, 4855 S MOORLAND ROAD, NEW BERLIN, WI 53151 12/01/2020 11/30/2022
09/28/2021 Page 115 of 222 Mental Health Program Directory By County, City, and Provider Name
CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1187
620 S 76TH SREET #240 TRICIA SCHUTZ Initial Cert: 01/01/1983 MILWAUKEE, WI 53214 [email protected] Cert Eff: 01/01/2020 County: Milwaukee Phone:(414) 292-4242 Cert Exp: 12/31/2021 Surveyor: Kelley Clark Fax: (414) 292-4182
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 CHILDREN'S SERV SOC OF WI - WELL-BEING SUMMIT, 6737 W WASHINGTON ST, MILWAUKEE, WI 01/01/2020 12/31/2021 53214 1 MILWAUKEE SCHOOL OF THE ARTS, 2300 W HIGHLAND AVE, MILWAUKEE, WI 53233 07/13/2021 12/31/2021
2 CHILDREN'S SERV SOC OF WI - MILWAUKEE, 620 S 76TH ST, STE 120, MILWAUKEE, WI 53214 01/01/2020 12/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates ATWATER ELEMENTARY, 2100 E CAPITOL DR, MILWAUKEE, WI 53211 01/01/2020 12/31/2021 AUER AVENUE SCHOOL, 2319 W AUER AVE, MILWAUKEE, WI 53206 01/01/2020 12/31/2021 DIVINE SAVIOR HOLY ANGELS, 4257 N 100TH STREET, MILWAUKEE, WI 53222 09/14/2020 12/31/2021 DR MARTIN LUTHER KING ELEMENTARY, 3275 N 3RD ST, MILWAUKEE, WI 53212 01/01/2020 12/31/2021 GREATER HOLY TEMPLE CHRISTIAN ACADEMY, 5575 N 76TH ST, MILWAUKEE, WI 53218 01/01/2020 12/31/2021 JAMES MADISON ACADEMIC CAMPUS, 8135 W FLORIST AVE, MILWAUKEE, WI 53218 01/01/2020 12/31/2021 LAKE BLUFF ELEMENTARY, 1600 E LAKE BLUFF BLVD, MILWAUKEE, WI 53211 01/01/2020 12/31/2021 MILWAUKEE SCHOOL OF LANGUAGES, 8400 W BURLEIGH ST, MILWAUKEE, WI 53208 01/01/2020 12/31/2021 NEXT DOOR, 2544 N 29TH STREET, MILWAUKEE, WI 53210 07/13/2021 12/31/2021 NEXT DOOR, 5310 W CAPITOL DRIVE, MILWAUKEE, WI 53216 07/13/2021 12/31/2021 RIVERWEST ELEMENTARY SCHOOL, 2765 N FRATNEY ST, MILWAUKEE, WI 53212 01/01/2020 12/31/2021 SHOREWOOD HIGH SCHOOL, 1701 E CAPITOL DR, MILWAUKEE, WI 53211 01/01/2020 12/31/2021 SHOREWOOD INTERMEDIATE, 3830 N MORRIS BLVD, MILWAUKEE, WI 53211 01/01/2020 12/31/2021
COMMUNITY RELATIONS SOCIAL DEVELOPMENT COMMISSION (SDC) 2373
1730 W NORTH AVENUE SHEILA SAMPTON Initial Cert: 04/29/2002 MILWAUKEE, WI 53205 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 906-2700 Cert Exp: 04/30/2022 Surveyor: Connie Knezic Fax: (414) 906-2719
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 SDC NORTHWEST, 9155 N. 76TH ST., MILWAUKEE, WI 53223 05/10/2021 04/30/2022
COMPREHENSIVE CLINICAL & CONSULTING SERVICES INC 1233
7161 N PORT WASHINGTON RD ELISE SCHULHAUSER Initial Cert: 01/01/1982 MILWAUKEE, WI 53217 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 352-7682 Cert Exp: 08/31/2023 Surveyor: Kelley Clark Fax: (414) 352-7625
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 116 of 222 Mental Health Program Directory By County, City, and Provider Name
CREATIVE COUNSELING OF MILWAUKEE 3236
2266 N PROSPECT AVE #304 CRAIG STONE Initial Cert: 10/24/2018 MILWAUKEE, WI 53209 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 405-0670 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (608) 305-2626
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
CURRENT INITIATIVES COUNSELING SERVICE II, LLC 3283
11414 W PARK PLACE, STE 202 LASHAWNDA DAVIS Initial Cert: 08/19/2020 MILWAUKEE, WI 53224 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 628-5495 Cert Exp: 07/31/2023 Surveyor: Connie Knezic Fax: (414) 918-8218
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
FOKUS FAMILY SERVICES 2473
2821 N VEL R PHILLIPS AVE, #123 ELZORA COLLINS Initial Cert: 03/01/2014 MILWAUKEE, WI 53212 [email protected] Cert Eff: 03/01/2020 County: Milwaukee Phone:(414) 264-4217 Cert Exp: 02/28/2022 Surveyor: Connie Knezic Fax: (414) 264-4218
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
FORWARD CHOICES LLC 2785
6040 W LISBON AVENUE, #103 MICHAEL WALLNER Initial Cert: 05/14/2008 MILWAUKEE, WI 53210 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 442-1751 Cert Exp: 04/30/2023 Surveyor: Kelley Clark Fax: (414) 442-1775
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
GATEWAY TO CHANGE 2479
2319 W. CAPITOL DRIVE GLENDA HAMPTON Initial Cert: 10/29/2003 MILWAUKEE, WI 53206 [email protected] Cert Eff: 12/01/2020 County: Milwaukee Phone:(414) 442-2033 Cert Exp: 11/30/2022 Surveyor: Connie Knezic Fax: (414) 442-2167
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2020 11/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 117 of 222 Mental Health Program Directory By County, City, and Provider Name
GERALD L IGNACE INDIAN HEALTH CENTER 3040
930 W HISTORIC MITCHELL ST DEBORAH BLACK Initial Cert: 08/01/2014 MILWAUKEE, WI 53204 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 316-5046 Cert Exp: 07/31/2023 Surveyor: Kelley Clark Fax: (414) 649-2719
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
GREENSQUARE DEVELOPMENTAL SPECIALISTS 2747
3365 S 103RD STREET JENNIFER SCOTT Initial Cert: 08/17/2007 MILWAUKEE, WI 53227 [email protected] Cert Eff: 08/01/2020 County: Milwaukee Phone:(414) 228-4800 Cert Exp: 07/31/2022 Surveyor: Connie Knezic Fax: (414) 247-0894
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 GREENSQUARE BAYSHORE, 7950 N PORT WASHINGTON RD, FOX POINT, WI 53217 08/01/2020 07/31/2022 1 GREENSQUARE COA GOLDIN CENTER, 2320 WEST BURLEIGH ST, MILWAUKEE, WI 53206 08/01/2020 07/31/2022 1 GREENSQUARE YMCA, 1350 W NORTH AVE, MILWAUKEE, WI 53205 08/01/2020 07/31/2022
2 GREENSQUARE FRANKLIN, 7322 W RAWSON AVE, FRANKLIN, WI 53132 08/01/2020 07/31/2022 2 GREENSQUARE RIVER GLEN, 4655 N PORT WASHINGTON RD #200, GLENDALE, WI 53212 08/01/2020 07/31/2022 2 GREENSQUARE MEQUON, 1655 W MEQUON ROAD, MEQUON, WI 53092 08/01/2020 07/31/2022 2 GREENSQUARE MIDTOWN, 5433 WEST FOND DU LAC AVE, MILWAUKEE, WI 53216 08/01/2020 07/31/2022 2 GREENSQUARE NEXT DOOR, 2561 NORTH 29TH ST, MILWAUKEE, WI 53216 08/01/2020 07/31/2022 2 GREENSQUARE FOREST VIEW, 4855 S MOORELAND RD SUITE 150, NEW BERLIN, WI 53151 08/01/2020 07/31/2022 2 GREENSQUARE PEWAUKEE, 1215 GEORGE TOWNE DR, PEWAUKEE, WI 53072 08/01/2020 07/31/2022
GRO FAMILY SERVICES 2803
2436 NORTH 50TH STREET GREGORY OWENS Initial Cert: 08/28/2008 MILWAUKEE, WI 53210 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 445-1400 Cert Exp: 09/30/2021 Surveyor: Connie Knezic Fax: (414) 395-4716
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2021 09/30/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 09/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 09/30/2021 NO BRANCH LOCATIONS
GUEST HOUSE COUNSELING CLINIC 2101
1216 N. 13TH STREET CATILLIA SEARCY Initial Cert: 07/15/1992 MILWAUKEE, WI 53205 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 345-3240 Cert Exp: 07/31/2023 Surveyor: Kelley Clark Fax: (414) 345-3258
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 118 of 222 Mental Health Program Directory By County, City, and Provider Name
HORIZON HEALTHCARE INC 2174
4650 S HOWELL AVENUE TIFFANY SANCHEZ Initial Cert: 11/01/1999 MILWAUKEE, WI 53207 [email protected] Cert Eff: 12/01/2019 County: Milwaukee Phone:(414) 376-5577 Cert Exp: 11/30/2021 Surveyor: Connie Knezic Fax: (414) 762-9727
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/27/2020 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 2 HORIZON HEALTHCARE INC, 3410 80TH STREET, KENOSHA, WI 53142 12/01/2019 11/30/2021 2 HORIZON HEALTHCARE INC, 2819 W HIGHLAND BLVD, MILWAUKEE, WI 53208 12/12/2019 11/30/2021 2 HORIZON HEALTHCARE INC, 2835 N 32ND ST, MILWAUKEE, WI 53208 11/05/2020 11/30/2021 2 HORIZON HEALTHCARE INC, 5408 W BURLEIGH ST, MILWAUKEE, WI 53210 12/01/2019 11/30/2021 2 HORIZON HEALTHCARE INC, 835 WISCONSIN AVE, RACINE, WI 53403 12/01/2019 11/30/2021 2 HORIZON HEALTHCARE INC, 217 WISCONSIN AVE #202, WAUKESHA, WI 53186 03/22/2021 11/30/2021
INTEGRATIVE PSYCHE LLC 3261
10150 W NATIONAL AVE STE 390 NICOLE KLEPP, PSY.D. Initial Cert: 01/01/2020 MILWAUKEE, WI 53227 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 545-4430 Cert Exp: 12/31/2023 Surveyor: Connie Knezic Fax: (414) 545-4454
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2023 NO BRANCH LOCATIONS
JEWISH FAMILY SERVICES 1450
1300 N JACKSON STREET ANNE DAVID Initial Cert: 06/01/1979 MILWAUKEE, WI 53202 [email protected] Cert Eff: 09/01/2020 County: Milwaukee Phone:(414) 390-5800 Cert Exp: 05/31/2022 Surveyor: Kelley Clark Fax: (414) 390-5808
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 JEWISH FAMILY SVS - BRADLEY CROSSING, 4375 WEST BRADLEY ROAD, BROWN DEER, WI 53223 09/01/2020 05/31/2022 1 SOJOURNER FAMILY PEACE CTR, 619 WEST WALNUT ST, MILWAUKEE, WI 53212 09/01/2020 05/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates JEWISH FAMILY SVS BROWN DEER ELEMENTARY, 5757 WEST DEAN ROAD, BROWN DEER, WI 09/01/2020 05/31/2022 53223 JEWISH FAMILY SVS CENTRAL CITY CYBERSCHOOL, 4301 NORTH 44TH ST, MILWAUKEE, WI 53216 09/01/2020 05/31/2022 JEWISH FAMILY SVS-BROWN DEER MIDDLE/HIGH SCHOOL, 8060 NORTH 60TH STREET, 09/01/2020 05/31/2022 MILWAUKEE, WI 53223
09/28/2021 Page 119 of 222 Mental Health Program Directory By County, City, and Provider Name
LAD LAKE - ST ROSE CENTER 1876
3801 N. 88TH STREET KARIE LOWE Initial Cert: 07/05/1985 MILWAUKEE, WI 53222 [email protected] Cert Eff: 09/01/2020 County: Milwaukee Phone:(414) 763-3511 Cert Exp: 08/31/2022 Surveyor: Kelley Clark Fax: (414) 466-0730
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 LAD LAKE, INC. DOUSMAN, W350 - S1401 WATERVILLE ROAD, DOUSMAN, WI 53118 09/01/2020 08/31/2022
LIFE CHANGING MINISTRIES INC 3045
2363 S 13TH STREET RENEE BOSWELL Initial Cert: 07/16/2014 MILWAUKEE, WI 53205 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 269-9660 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: () -
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2020 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 LIFE CHANGING MINISTRIES, 6737 N TEUTONIA AVE, MILWAUKEE, WI 53209 08/02/2021 09/30/2022
LIGHTHOUSE CLINIC, LLC 1509
2524 E WEBSTER PLACE #203 MARGO RENNER Initial Cert: 01/01/1990 MILWAUKEE, WI 53211 [email protected] Cert Eff: 02/01/2020 County: Milwaukee Phone:(414) 964-9200 Cert Exp: 01/31/2022 Surveyor: Kelley Clark Fax: (414) 964-4816
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 LIGHTHOUSE CLINIC, 11803 W NORTH AVENUE, #207, MILWAUKEE, WI 53226 02/01/2020 01/31/2022
LOCKETT ENTERPRISE LLC BEHAVIORAL HEALTH SERVICES 3039
1845 NORTH FARWELL AVE SUITE 301 OTIS LOCKETT JR. Initial Cert: 07/29/2014 MILWAUKEE, WI 53202 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 223-3815 Cert Exp: 07/31/2023 Surveyor: Connie Knezic Fax: (414) 223-3817
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2021 07/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 120 of 222 Mental Health Program Directory By County, City, and Provider Name
M & S CLINICAL SERVICES, INC 3223
2821 N VEL R PHILLIPS AVE, STE 210 MARK FOSSIE Initial Cert: 08/28/2018 MILWAUKEE, WI 53212 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 263-6000 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 263-2270
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 10/31/2021 NO BRANCH LOCATIONS
MANNA BEHAVIORAL SERVICES 3213
2821 VEL R PHILLIPS AVE #223 CLEM L RICHARDSON Initial Cert: 09/01/2018 MILWAUKEE, WI 53212 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 334-7022 Cert Exp: 08/31/2023 Surveyor: Connie Knezic Fax: (414) 585-0115
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA 1580
1155 N MAYFAIR ROAD BOB HUBERTY Initial Cert: 07/01/1996 MILWAUKEE, WI 53226 [email protected] Cert Eff: 02/01/2021 County: Milwaukee Phone:(414) 955-8900 Cert Exp: 01/31/2023 Surveyor: Connie Knezic Fax: (414) 955-6295
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
MD THERAPY 2225
6815 W CAPITOL DRIVE, #208 THOMAS (MIKE) DALE Initial Cert: 05/05/2000 MILWAUKEE, WI 53216 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 466-3204 Cert Exp: 05/31/2022 Surveyor: Connie Knezic Fax: (414) 466-3206
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 121 of 222 Mental Health Program Directory By County, City, and Provider Name
META HOUSE, INC. 2172
2625 N WEIL STREET SARAH JOYCE Initial Cert: 11/24/1999 MILWAUKEE, WI 53212 [email protected] Cert Eff: 12/01/2019 County: Milwaukee Phone:(414) 962-1200 Cert Exp: 11/30/2021 Surveyor: Kelley Clark Fax: (414) 962-2305
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2019 11/30/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
MHA - WI WELLNESS CLINIC 3187
600 W VIRGINIA ST SUITE #502 TERRI ELLZEY Initial Cert: 11/15/2017 MILWAUKEE, WI 53204 [email protected] Cert Eff: 12/01/2020 County: Milwaukee Phone:(414) 336-7962 Cert Exp: 11/30/2022 Surveyor: Kelley Clark Fax: (414) 276-3124
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2020 11/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
MILWAUKEE CENTER FOR INDEPENDANCE DBA WHOLE HEALTH CLINICAL GROUP 1933
2020 W WELLS ST, STE WHCG LL 100-114 JAMES WELSH Initial Cert: 09/01/1985 MILWAUKEE, WI 53223 [email protected] Cert Eff: 06/07/2021 County: Milwaukee Phone:(414) 476-9675 Cert Exp: 05/31/2023 Surveyor: Connie Knezic Fax: (414) 615-0627
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/07/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/07/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 CRISIS RESOURCE CENTER NORTH, 5409 W VILLARD AVE, MILWAUKEE, WI 53218 06/07/2021 05/31/2023 1 CRISIS RESOURCE CENTER SOUTH, 2057 S 14TH STREET, MILWAUKEE, WI 53204 06/07/2021 05/31/2023 1 CRISIS RESOURCE CENTER WEST, 5566 N 69TH ST, MILWAUKEE, WI 53203 06/07/2021 05/31/2023 1 EMPLOYMENT & COMMUNITY SVS, 3333 S HOWELL AVE, MILWAUKEE, WI 53207 06/07/2021 05/31/2023
MILWAUKEE CENTER FOR INDEPENDENCE DBA WHOLE HEALTH CLINICAL GROUP CSP 2125
2020 W WELLS ST, STE WHCG LL 100-114 ERIC HERZ Initial Cert: 09/01/1985 MILWAUKEE, WI 53223 [email protected] Cert Eff: 07/01/2021 County: Milwaukee Phone:(414) 615-1421 Cert Exp: 06/30/2023 Surveyor: Connie Knezic Fax: (414) 615-0627
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 122 of 222 Mental Health Program Directory By County, City, and Provider Name
MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION 1632
9455 WATERTOWN PLANK ROAD MICHAEL LAPPEN Initial Cert: 08/01/1977 MILWAUKEE, WI 53226 [email protected] Cert Eff: 11/01/2019 County: Milwaukee Phone:(414) 257-5202 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 257-8119 Crisis Intervention Services Regional Designation Begin End Lead SINGLE COUNTY CCS REGION - MILWAUKEE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2019 10/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION CHILDREN'S MOBILE CRISIS TEAM 1634
9455 WATERTOWN PLANK ROAD LATOYA JOHNSON Initial Cert: 11/01/1996 MILWAUKEE, WI 53226 [email protected] Cert Eff: 11/01/2019 County: Milwaukee Phone:(414) 257-7385 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 257-8126 Crisis Intervention Services Regional Designation Begin End Lead SINGLE COUNTY CCS REGION - MILWAUKEE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
MILWAUKEE COUNTY CARS ACT CSP 3337
9455 W WATERTOWN PLANK ROAD KAELIN DEPREZ Initial Cert: 08/25/2021 MILWAUKEE, WI 53226 [email protected] Cert Eff: 08/25/2021 County: Milwaukee Phone:(414) 257-7405 Cert Exp: 06/30/2023 Surveyor: Kelley Clark Fax: (414) 257-5507
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/25/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 123 of 222 Mental Health Program Directory By County, City, and Provider Name
MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM 3037
9455 WEST WATERTOWN PLANK ROAD JENNIFER WITTWER Initial Cert: 09/01/2014 MILWAUKEE, WI 53226 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 257-8085 Cert Exp: 08/31/2023 Surveyor: Connie Knezic Fax: (414) 545-4242
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 LA CAUSA, INC, 5235 N IRONWOOD RD, GLENDALE, WI 53217 09/01/2021 08/31/2023 2 BROADSTEP, 3090 N 53RD STREET, MILWAUKEE, WI 53210 09/01/2021 08/31/2023 2 JEWISH FAMILY SERVICES, INC., 1300 N JACKSON ST, MILWAUKEE, WI 53202 09/01/2021 08/31/2023 2 LAD LAKE, INC, 3801 N 88TH ST, MILWAUKEE, WI 53222 09/01/2021 08/31/2023 2 MCFI DBA WHOLE HEALTH GROUP, 2020 W WELLS ST, MILWAUKEE, WI 53223 09/01/2021 08/31/2023 2 MILWAUKEE MENTAL HEALTH ASSOCIATES, INC, 3975 N 68TH STREET, MILWAUKEE, WI 53216 09/01/2021 08/31/2023 2 OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI 53206 09/01/2021 08/31/2023 2 PATHFINDERS MILWAUKEE, INC, 4200 N HOLTON ST STE 400, MILWAUKEE, WI 53212 09/01/2021 08/31/2023 2 PROJECT ACCESS, INC, 823 S 60TH ST, MILWAUKEE, WI 53214 09/01/2021 08/31/2023 2 SAINT A, 8901 W CAPITOL DR, MILWAUKEE, WI 53222 09/01/2021 08/31/2023 2 SIRONA RECOVERY INC, 111 W PLEASANT ST STE #202, MILWAUKEE, WI 53212 09/01/2021 08/31/2023 2 SIXTEENTH STREET COMMUNITY HEALTH CENTERS, 1635 W NATIONAL AVE, MILWAUKEE, WI 09/01/2021 08/31/2023 53204 2 ST CHARLES YOUTH & FAM SVC, 151 S 84TH ST, MILWAUKEE, WI 53214 09/01/2021 08/31/2023 2 THE GUEST HOUSE OF MILWAUKEE, 1216 N 13TH STREET, MILWAUKEE, WI 53205 09/01/2021 08/31/2023 2 WISCONSIN COMMUNITY SERVICES, 2620 W NORTH AVE, MILWAUKEE, WI 53205 09/01/2021 08/31/2023 2 WISCONSIN COMMUNITY SERVICES, 3732 W WISCONSIN AVE #330, MILWAUKEE, WI 53208 09/01/2021 08/31/2023 2 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, 10045 W LISBON AVENUE, WAUWATOSA, 09/01/2021 08/31/2023 WI 53222 2 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, 6737 W WASHINGTON ST #1325, WEST ALLIS, 09/01/2021 08/31/2023 WI 53214 2 PROFESSIONAL SERVICES GROUP INC, 1205 S 70TH ST, #301, WEST ALLIS, WI 53214 09/01/2021 08/31/2023
MILWAUKEE HEALTH SERVICES, INC. DBA BEHAVIORAL HEALTH SERVICES CENTER 1642
8200 W SILVER SPRING DRIVE QUIANA MANN Initial Cert: 05/01/1994 MILWAUKEE, WI 53218 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 267-2085 Cert Exp: 04/30/2023 Surveyor: Kelley Clark Fax: (414) 464-6472
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 MARTIN LUTHER KING-HERITAGE HEALTH CENTER, 2555 N MARTIN LUTHER KING JR DRIVE, 05/01/2021 04/30/2023 MILWAUKEE, WI 53212
MILWAUKEE MENTAL HEALTH ASSOCIATES COMMUNITY SUPPORT PROGRAM 1645
3975 N 68TH STREET CHANTIL HARRIS Initial Cert: 02/18/1997 MILWAUKEE, WI 53216 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 873-1960 Cert Exp: 07/31/2023 Surveyor: Kelley Clark Fax: (414) 873-4990
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2021 07/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 MILWAUKEE MENTAL HEALTH ASSOCIATES, INC - NATIONAL, 3073 S CHASE AVE, SUITE 100, 08/01/2021 07/31/2023 MILWAUKEE, WI 53207
09/28/2021 Page 124 of 222 Mental Health Program Directory By County, City, and Provider Name
MWCCA BEHAVIORAL HEALTH CLINIC 1794
4906 W FOND DU LAC AVE OTIS LOCKETT JR Initial Cert: 02/01/1988 MILWAUKEE, WI 53216 [email protected] Cert Eff: 07/01/2021 County: Milwaukee Phone:(414) 270-4699 Cert Exp: 06/30/2023 Surveyor: Connie Knezic Fax: (414) 270-3793
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 07/01/2021 06/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
NEW CHOICES, LLC 2930
3565 N DR MARTIN LUTHER KING DR LEOLA WILLIAMS Initial Cert: 10/14/2010 MILWAUKEE, WI 53212 [email protected] Cert Eff: 10/01/2021 County: Milwaukee Phone:(414) 444-8445 Cert Exp: 09/30/2023 Surveyor: Connie Knezic Fax: (414) 444-8432
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2021 09/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
OUTREACH COMMUNITY HEALTH CENTER INC RECOVERY CSP 1777
711 W CAPITOL DRIVE MARY ZYLSTRA Initial Cert: 07/17/1996 MILWAUKEE, WI 53206 [email protected] Cert Eff: 07/01/2021 County: Milwaukee Phone:(414) 374-2400 Cert Exp: 06/30/2023 Surveyor: Connie Knezic Fax: (414) 374-7917
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
OUTREACH COMMUNITY HEALTH CENTERS INC 2246
210 W CAPITOL DRIVE ANNIE CARRELL Initial Cert: 08/01/2000 MILWAUKEE, WI 53212 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 727-6320 Cert Exp: 07/31/2023 Surveyor: Connie Knezic Fax: (414) 962-3861
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI 53206 08/01/2021 07/31/2023
09/28/2021 Page 125 of 222 Mental Health Program Directory By County, City, and Provider Name
PARADIGM ENRICHMENT SERVICES, INC. 2990
4222 W CAPITOL DR, 1ST FLOOR FRED JACKSON II Initial Cert: 03/25/2013 MILWAUKEE, WI 53216 [email protected] Cert Eff: 07/01/2020 County: Milwaukee Phone:(262) 241-7500 Cert Exp: 02/28/2022 Surveyor: Connie Knezic Fax: (262) 241-7501
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 07/01/2020 08/05/2020 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 02/28/2022 NO BRANCH LOCATIONS
PENFIELD CHILDREN'S CENTER 2923
833 N 26TH STREET HEATHER ROTOLO Initial Cert: 10/01/2010 MILWAUKEE, WI 53233 [email protected] Cert Eff: 10/01/2019 County: Milwaukee Phone:(414) 345-6337 Cert Exp: 09/30/2021 Surveyor: Kelley Clark Fax: (414) 344-7739
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
POSITIVE OUTLOOK CLINICAL SERVICES LLC 2796
6815 W CAPITOL DR, SUITE 304 PAMELA HANSEN Initial Cert: 08/01/2008 MILWAUKEE, WI 53216 [email protected] Cert Eff: 08/01/2020 County: Milwaukee Phone:(414) 460-6995 Cert Exp: 07/31/2022 Surveyor: Connie Knezic Fax: (414) 355-5467
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022 NO BRANCH LOCATIONS
PROJECT ACCESS, INC. CSP 1751
823 S 60TH STREET G ROGER ZHONG Initial Cert: 12/20/1995 MILWAUKEE, WI 53214 [email protected] Cert Eff: 03/01/2021 County: Milwaukee Phone:(414) 456-1155 Cert Exp: 02/28/2023 Surveyor: Connie Knezic Fax: (414) 456-1655
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
PSYCARE-MILWAUKEE LLC 1445
633 W. WISCONSIN AVENUE, #1810 THOMAS A GARLAND Initial Cert: 06/04/2007 MILWAUKEE, WI 53203 [email protected] Cert Eff: 09/01/2020 County: Milwaukee Phone:(414) 271-3322 Cert Exp: 05/31/2022 Surveyor: Kelley Clark Fax: (414) 271-2335
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 126 of 222 Mental Health Program Directory By County, City, and Provider Name
RENEW COUNSELING SERVICES 1792
1225 W. MITCHELL STREET, #223 WAYNE CROATT Initial Cert: 04/01/1985 MILWAUKEE, WI 53204 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 383-4455 Cert Exp: 08/31/2023 Surveyor: Kelley Clark Fax: (414) 727-8730
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 127 of 222 Mental Health Program Directory By County, City, and Provider Name
SAINT A 3205
8901 W CAPITOL DR JODY PAHLAVAN Initial Cert: 06/04/2018 MILWAUKEE, WI 53222 [email protected] Cert Eff: 06/01/2021 County: Milwaukee Phone:(414) 465-5751 Cert Exp: 05/31/2023 Surveyor: Connie Knezic Fax: (414) 463-2770
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 3 GERMANTOWN HIGH SCHOOL, W180 N11501 RIVER LN, GERMANTOWN, WI 53022 06/01/2021 05/31/2023 3 ARROWHEAD HIGH SCHOOL, 700 NORTH AVE, HARTLAND, WI 53029 06/01/2021 05/31/2023 3 BEN FRANKLIN ELEMENTARY, N81 W14701 FRANKLIN DR, MENOMONEE FALLS, WI 53051 06/01/2021 05/31/2023 3 RIVERSIDE ELEMENTARY, W153N8681 MARGARET RD, MENOMONEE FALLS, WI 53051 06/01/2021 05/31/2023 3 SHADY LANE ELEMENTARY, W172 N8959 SHADY LN, MENOMONEE FALLS, WI 53051 06/01/2021 05/31/2023 3 VALLEY VIEW ELEMENTARY, W180 N8130 TOWN HALL RD, MENOMONEE FALLS, WI 53051 06/01/2021 05/31/2023 3 CARMEN NORTHWEST CAMPUS, 5496 NORTH 72ND ST, MILWAUKEE, WI 53218 06/01/2021 05/31/2023 3 CENTRAL CITY CYBERSCHOOL, 4301 N 44TH ST, MILWAUKEE, WI 53216 06/01/2021 05/31/2023 3 LONGFELLOW MIDDLE SCHOOL, 7600 W NORTH AVE, MILWAUKEE, WI 53213 06/01/2021 05/31/2023 3 SEEDS OF HEALTH ELEMENTARY, 1445 S 32ND ST, MILWAUKEE, WI 53215 06/01/2021 05/31/2023 3 TENOR HS - 1ST ST CAMPUS, 131 S 1ST ST, MILWAUKEE, WI 53204 06/01/2021 05/31/2023 3 TENOR HS - JACKSON CAMPUS, 840 N JACKSON ST, MILWAUKEE, WI 53202 06/01/2021 05/31/2023 3 VERITAS HS, 3025 W OKLAHOMA AVE, MILWAUKEE, WI 53215 06/01/2021 05/31/2023 3 HOOVER ELEMENTARY, 12705 W EUCLID AVE, NEW BERLIN, WI 53151 06/01/2021 05/31/2023 3 HORIZON ELEMENTARY SCHOOL, 458 LAKE ST, PEWAUKEE, WI 53072 06/01/2021 05/31/2023 3 PEWAUKEE HIGH SCHOOL, 510 LAKE ST, PEWAUKEE, WI 53072 06/01/2021 05/31/2023 3 PEWAUKEE LAKE ELEMENTARY, 436 LAKE ST, PEWAUKEE, WI 53072 06/01/2021 05/31/2023 3 BLAKEWOOD ELEMENTARY SCHOOL, 3501 BLAKEWOOD AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 E W LUTHER ELEMETARY, 718 HAWTHORNE AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 LAKEVIEW ELEMENTARY, 711 MARION AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 RAWSON ELEMENTARY, 1410 RAWSON AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 SOUTH MILWAUKEE HIGH SCHOOL, 801 15TH AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 SOUTH MILWAUKEE MIDDLE, 1001 15TH AVE, SOUTH MILWAUKEE, WI 53172 06/01/2021 05/31/2023 3 FRANK LLOYD WRIGHT INT, 9501 W CLEVELAND AVE, WEST ALLIS, WI 53227 06/01/2021 05/31/2023 3 FRANKLIN ELEMENTARY, 2060 86TH ST, WEST ALLIS, WI 53227 06/01/2021 05/31/2023 3 HORACE MANN ELEMENTARY, 6213 W LAPHAM ST, WEST ALLIS, WI 53214 06/01/2021 05/31/2023 3 LONGFELLOW ELEMENTARY, 2211 S 60TH ST, WEST ALLIS, WI 53219 06/01/2021 05/31/2023 3 WEST MILWAUKEE INT, 5104 GREENFIELD AVE, WEST ALLIS, WI 53214 06/01/2021 05/31/2023 3 WILSON ELEMENTARY, 8710 W ORCHARD ST, WEST ALLIS, WI 53214 06/01/2021 05/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates SOUTHSIDE COMMUNITY PREP, 3003 W CLEVELAND AVE, MILWAUKEE, WI 53215 08/19/2021 05/31/2023 TRANSFORMATION PREP, 5501 N 68TH ST, MILWAUKEE, WI 53218 08/19/2021 05/31/2023
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SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC 2495
1720 W FLORIST AVENUE #125 SEBASTIAN SSEMPIJJA Initial Cert: 01/14/2004 MILWAUKEE, WI 53209 [email protected] Cert Eff: 03/01/2021 County: Milwaukee Phone:(414) 247-0801 Cert Exp: 12/31/2022 Surveyor: Kelley Clark Fax: (414) 247-0816
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 SEBASTIAN FAMILY PSYCHOLOGY, 2745 W LAYTON AVE, STE 203, MILWAUKEE, WI 53221 03/01/2021 12/31/2022
3 AUDUBON TECHNOLOGY & COMMUNICATION CENTER, 3300 S 39TH ST, MILWAUKEE, WI 53215 03/01/2021 12/31/2022 3 BENJAMIN FRANKLIN SCHOOL, 2308 W NASH ST, MILWAUKEE, WI 53206 03/01/2021 12/31/2022 3 BETHUNE ACADEMY, 1535 N 35TH ST, MILWAUKEE, WI 53208 03/01/2021 12/31/2022 3 HENRY DAVID THOREAU, 7878 N 60TH ST, MILWAUKEE, WI 53223 03/01/2021 12/31/2022 3 KEEFE AVENUE ELEMENTARY SCHOOL, 1618 W KEEFE AVE, MILWAUKEE, WI 53206 03/01/2021 12/31/2022 3 MILW COLLEGE PREP LLOYD ST, 1228 W LLOYD ST, MILWAUKEE, WI 53205 03/01/2021 12/31/2022 3 OLIVER WENDALL HOLMES SCHOOL, 2463 N BUFFUM ST, MILWAUKEE, WI 53212 03/01/2021 12/31/2022 3 SHALOM HIGH SCHOOL, 1749 N 16TH ST, MILWAUKEE, WI 53205 03/01/2021 12/31/2022 3 SHERMAN MULTICULTURAL ARTS SCHOOL, 5110 W LOCUST ST, MILWAUKEE, WI 53210 03/01/2021 12/31/2022
SIXTEENTH STREET BEHAVIORAL HEALTH CENTER 1011
1032 S CESAR E CHAVEZ DRIVE MARIA PEREZ Initial Cert: 10/15/1997 MILWAUKEE, WI 53204 [email protected] Cert Eff: 11/01/2020 County: Milwaukee Phone:(414) 672-1353 Cert Exp: 10/31/2022 Surveyor: Connie Knezic Fax: (414) 383-5597
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 PARKWAY CLINIC, 2906 S 20TH STREET, MILWAUKEE, WI 53215 11/01/2020 10/31/2022 1 WAUKESHA COMMUNITY HEALTH CENTER, 309 E. NORTH STREET, WAUKESHA, WI 53188 11/01/2020 10/31/2022
2 NATIONAL AVE COMMUNITY HEALTH CENTER, 1635 W NATIONAL AVE, MILWAUKEE, WI 53204 11/01/2020 10/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ZABLOCKI ELEMENTARY SCHOOL, 1016 WEST OKLAHOMA AVE, MILWAUKEE, WI 53215 11/06/2020 10/31/2022
SIXTEENTH STREET COMMUNITY HEALTH CENTERS - LAYTON 3199
4570 S 27TH STREET MARIA ELENA PEREZ, PHD Initial Cert: 04/01/2018 MILWAUKEE, WI 53221 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 672-1353 Cert Exp: 03/31/2023 Surveyor: Connie Knezic Fax: (414) 383-5597
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 03/31/2023 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 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 SIXTEENTH STREET COMMUNITY - NATIONAL CLINIC, 1635 W NATIONAL AVE, MILWAUKEE, WI 04/01/2021 03/31/2023 53204
09/28/2021 Page 129 of 222 Mental Health Program Directory By County, City, and Provider Name
SMILE INC MENTAL HEALTH AND AODA OUTPATIENT CLINIC 3201
4222 W CAPITOL DR #308 ANNETTE VEASEY Initial Cert: 04/02/2018 MILWAUKEE, WI 53216 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 231-9996 Cert Exp: 03/31/2023 Surveyor: Connie Knezic Fax: (414) 249-3312
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 04/01/2021 03/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 03/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
ST LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC 2690
2900 W OKLAHOMA AVENUE CARRIE SLOMSKI Initial Cert: 08/30/2006 MILWAUKEE, WI 53215 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 454-6454 Cert Exp: 08/31/2023 Surveyor: Connie Knezic Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER 1322
4757 N. 76TH STREET SCOTT CARPENTER Initial Cert: 01/01/1991 MILWAUKEE, WI 53218 [email protected] Cert Eff: 02/01/2021 County: Milwaukee Phone:(414) 358-4145 Cert Exp: 01/31/2023 Surveyor: Connie Knezic Fax: (414) 219-9040
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 02/01/2021 01/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ST CHARLES - FAMILY DEVELOPMENT CENTER, 151 S 84TH STREET, MILWAUKEE, WI 53214 02/01/2021 01/31/2023
THE HUMAN DEVELOPMENT CENTER, INC. 2634
6833 WEST FOND DU LAC AVE CHUCK HOLLOWAY Initial Cert: 01/25/2006 MILWAUKEE, WI 53218 [email protected] Cert Eff: 02/01/2020 County: Milwaukee Phone:(414) 449-9908 Cert Exp: 01/31/2022 Surveyor: Kelley Clark Fax: (414) 449-9912
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 130 of 222 Mental Health Program Directory By County, City, and Provider Name
THE POWER OF CHANGE INC BEHAVIORAL SERVICES 2944
2821 N VEL R PHILLIPS AVE STE #131 RHONDA ARMON-BENT Initial Cert: 07/01/2011 MILWAUKEE, WI 53212 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 374-8787 Cert Exp: 12/31/2022 Surveyor: Connie Knezic Fax: (414) 374-8181
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
UNITED COMMUNITY CENTER 1657
1111 S 6TH STREET, 3RD FLOOR JUAN A. RUIZ Initial Cert: 05/01/1980 MILWAUKEE, WI 53204 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 384-3100 Cert Exp: 09/30/2022 Surveyor: Kelley Clark Fax: (414) 647-8602
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 04/01/2021 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022 NO BRANCH LOCATIONS
VIVENT HEALTH INC 2406
820 N. PLANKINTON AVENUE ANGELIQUE LEWIS Initial Cert: 10/02/2002 MILWAUKEE, WI 53203 [email protected] Cert Eff: 03/23/2021 County: Milwaukee Phone:(414) 225-1540 Cert Exp: 12/31/2022 Surveyor: Connie Knezic Fax: (414) 225-1628
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 03/23/2021 12/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/23/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/23/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 VIVENT HEALTH APPLETON, 633 C WEST WISCONSIN AVE, APPLETON, WI 54911 03/23/2021 12/31/2022 1 VIVENT HEALTH BELOIT, 136 W. GRAND AVENUE, BELOIT, WI 53511 03/23/2021 12/31/2022 1 VIVENT HEALTH EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI 54702 03/23/2021 12/31/2022 1 VIVENT HEALTH KENOSHA, 1212 - 57TH STREET, KENOSHA, WI 53140 03/23/2021 12/31/2022 1 VIVENT HEALTH LA CROSSE, 811 ROSE ST, LA CROSSE, WI 54603 03/23/2021 12/31/2022 1 VIVENT HEALTH MADISON, 600 WILLIAMS STREET, MADISON, WI 53703 03/23/2021 12/31/2022 1 VIVENT HEALTH WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI 54403 03/23/2021 12/31/2022
2 VIVENT HEALTH GREEN BAY, 445 S ADAMS STREET, GREEN BAY, WI 54301 03/23/2021 12/31/2022
WCS-YOUTH CRISIS STABILIZATION FACILITY 1 3308
4777 N 32ND STREET, 5TH FLOOR CHAD MEINHOLDT Initial Cert: 10/01/2020 MILWAUKEE, WI 53209 [email protected] Cert Eff: 04/20/2021 County: Milwaukee Phone:(414) 462-6043 Cert Exp: 09/30/2022 Surveyor: Kelley Clark Fax: (414) 462-6126
Services Adm Code Service Begin/End Dates MENTAL HEALTH YOUTH CRISIS STABILIZATION FACILITY DHS 50 04/20/2021 09/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 131 of 222 Mental Health Program Directory By County, City, and Provider Name
WCS-YOUTH CRISIS STABILIZATION FACILITY 2 3327
4777 N 32ND STREET, 4TH FLOOR CHAD MEINHOLDT Initial Cert: 05/24/2021 MILWAUKEE, WI 53209 [email protected] Cert Eff: 05/24/2021 County: Milwaukee Phone:(414) 462-6043 Cert Exp: 04/30/2023 Surveyor: Kelley Clark Fax: (414) 462-6126
Services Adm Code Service Begin/End Dates MENTAL HEALTH YOUTH CRISIS STABILIZATION FACILITY DHS 50 05/24/2021 04/30/2023 NO BRANCH LOCATIONS
WISCONSIN COMMUNITY SERVICES OUTPATIENT MENTAL HEALTH PROGRAM 1995
3734 W WISCONSIN AVENUE SUSAN COLLYARD Initial Cert: 06/01/1977 MILWAUKEE, WI 53208 [email protected] Cert Eff: 07/01/2021 County: Milwaukee Phone:(414) 343-3515 Cert Exp: 06/30/2023 Surveyor: Connie Knezic Fax: (414) 344-2191
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIAL 1955
3732 W WISCONSIN AVE STE 200 LYNORE FRISCIA Initial Cert: 06/01/1986 MILWAUKEE, WI 53208 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 290-0404 Cert Exp: 09/30/2022 Surveyor: Kelley Clark Fax: (414) 226-0351
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022 NO BRANCH LOCATIONS
WISCONSIN COMMUNITY SERVICES-COMMUNITY SUPPORT PROGRAM 1993
3734 W WISCONSIN AVENUE SUSAN COLLYARD Initial Cert: 11/01/1995 MILWAUKEE, WI 53208 [email protected] Cert Eff: 11/01/2020 County: Milwaukee Phone:(414) 343-3536 Cert Exp: 10/31/2022 Surveyor: Connie Knezic Fax: (414) 334-2191
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS 3149
510 E BURLEIGH ST ANDREA SEMMANN Initial Cert: 11/08/2016 MILWAUKEE, WI 53212 [email protected] Cert Eff: 12/23/2020 County: Milwaukee Phone:(262) 345-5527 Cert Exp: 10/31/2022 Surveyor: Connie Knezic Fax: (262) 345-5531
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 12/23/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/23/2021 10/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 132 of 222 Mental Health Program Directory By County, City, and Provider Name
WAUWATOSA ABG WELLNESS GROUP INC 3158
7332 W STATE ST, SUITE 6 CANDICE LIPSKI Initial Cert: 11/01/2016 WAUWATOSA, WI 53213 [email protected] Cert Eff: 11/01/2019 County: Milwaukee Phone:(414) 292-7060 Cert Exp: 10/31/2021 Surveyor: Connie Knezic Fax: (414) 973-2090
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 PARK PLACE OFFICE, 11414 W PARK PLACE STE 202, MILWAUKEE, WI 53224 11/01/2019 10/31/2021
ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C. 1033
10045 W LISBON AVENUE KAREN DREXLER Initial Cert: 11/20/1997 WAUWATOSA, WI 53222 [email protected] Cert Eff: 12/01/2019 County: Milwaukee Phone:(414) 358-7144 Cert Exp: 11/30/2021 Surveyor: Kelley Clark Fax: (414) 358-7158
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 2 ALTERNATIVES IN PSYCH CONSULT, 6737 W WASHINGTON ST SUITE 1300, WEST ALLIS, WI 53214 12/01/2019 11/30/2021
AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA 2518
1220 DEWEY AVENUE TANYA WASHINGTON Initial Cert: 03/31/2004 WAUWATOSA, WI 53213 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 587-1301 Cert Exp: 02/28/2023 Surveyor: Kelley Clark Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 02/28/2023 NO BRANCH LOCATIONS
AURORA PSYCHIATRIC HOSPITAL INC 1647
1220 DEWEY AVENUE BLDG 4 JAMIE SURFUS-LEWISTON Initial Cert: 09/01/1979 WAUWATOSA, WI 53213 [email protected] Cert Eff: 01/01/2021 County: Milwaukee Phone:(414) 454-6600 Cert Exp: 07/31/2022 Surveyor: Kelley Clark Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2021 07/31/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 01/01/2021 07/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2021 07/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 07/31/2022 NO BRANCH LOCATIONS
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AURORA PSYCHIATRIC HOSPITAL INC 3140
1220 DEWEY AVENUE BLDG 7 JAMIE SURFUS-LEWISTON Initial Cert: 08/01/2016 WAUWATOSA, WI 53213 [email protected] Cert Eff: 08/01/2021 County: Milwaukee Phone:(414) 454-6667 Cert Exp: 07/31/2023 Surveyor: Kelley Clark Fax: (414) 454-6662
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/01/2021 07/31/2023 MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 08/01/2021 07/31/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2021 08/31/2021 NO BRANCH LOCATIONS
LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN 1516
3800 N MAYFAIR ROAD DEBORAH L RAYBURN Initial Cert: 03/01/1978 WAUWATOSA, WI 53222 [email protected] Cert Eff: 04/01/2020 County: Milwaukee Phone:(414) 536-8333 Cert Exp: 03/31/2022 Surveyor: Kelley Clark Fax: (414) 536-8348
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
Tier Branch Location(s) Branch Begin/End Dates 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI 54923 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4850 S LAKE DRIVE, CUDAHY, WI 53110 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 2833 RARITAN, FITCHBURG, WI 53711 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 210 S ONEIDA ST, GREEN BAY, WI 54303 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 2940 MINERAL POINT AVE, JANESVILLE, WI 04/01/2020 03/31/2022 53548 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 400 N SAWYER ST, OSHKOSH, WI 54902 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG ST, PORTAGE, WI 53901 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 345 NORTH PINE ST, REEDSBURG, WI 53959 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 15 E SAWYER, RICE LAKE, WI 54868 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 324 S ANDREWS ST, SHAWANO, WI 54166 04/01/2020 03/31/2022 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E1887 KING ROAD, WAUPACA, WI 54981 04/01/2020 03/31/2022
2 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 300 BROADWAY DR, SUN PRAIRIE, WI 53590 04/01/2020 03/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BROWN DEER ELEMENTARY SCHOOL, 5757 W DEAN RD, BROWN DEER, WI 53223 04/01/2020 03/31/2022 BROWN DEER MIDDLE/HIGH SCHOOL, 8200 N 60TH ST, BROWN DEER, WI 53223 04/01/2020 03/31/2022 GRACE LUTHERAN SCHOOL, N87W16173 KENWOOD BLVD, MENOMONEE FALLS, WI 53051 04/01/2020 03/31/2022 ATONEMENT LUTHERAN SCHOOL, 4224 W RUBY AVE, MILWAUKEE, WI 53209 04/01/2020 03/31/2022 GRANVILLE LUTHERAN SCHOOL (LUMIN), 8242 N GRANVILLE DR, MILWAUKEE, WI 53224 04/01/2020 03/31/2022 MT CALVARY LUTHERAN SCHOOL, 2850 N 53RD ST, MILWAUKEE, WI 53210 04/01/2020 03/31/2022 NORTHWEST LUTHERAN SCHOOL, 4119 N 81ST ST, MILWAUKEE, WI 53222 04/01/2020 03/31/2022 RENAISSANCE LUTHERAN SCHOOL - TAYLOR (LUMIN), 6150 TAYLOR AVE, RACINE, WI 53403 04/01/2020 03/31/2022 RENAISSANCE LUTHERAN SCHOOL - VILLA, 1510 VILLA ST, RACINE, WI 53403 04/01/2020 03/31/2022 CONCORDIA LUTHERAN SCHOOL, 8500 DURAND AVE, STURTEVANT, WI 53177 04/01/2020 03/31/2022 BEAUTIFUL SAVIOR LUTHERAN SCHOOL, 1205 EAST AVE, WAUKESHA, WI 53186 04/01/2020 03/31/2022 OUR REDEEMER LUTHERAN SCHOOL, 10025 W NORTH AVE, WAUWATOSA, WI 53226 04/01/2020 03/31/2022 PILGRIM LUTHERAN SCHOOL (LUMIN), 6717 W CENTER ST, WAUWATOSA, WI 53210 04/01/2020 03/31/2022
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MINDSTAR COUNSELING, LLC 2891
4025 N. 92ND STREET STARLETTE PATTERSONBIDDLE Initial Cert: 12/01/2009 WAUWATOSA, WI 53222 [email protected] Cert Eff: 02/01/2021 County: Milwaukee Phone:(414) 435-1115 Cert Exp: 11/30/2022 Surveyor: Connie Knezic Fax: (414) 435-0543
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 02/01/2021 11/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 11/30/2022 NO BRANCH LOCATIONS
RISE YOUTH & FAMILY SERVICES, LLC 3101
8500 W NORTH AVENUE SARA NEWMAN Initial Cert: 10/20/2015 WAUWATOSA, WI 53226 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 559-8864 Cert Exp: 09/30/2022 Surveyor: Kelley Clark Fax: (414) 433-1919
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
THE REDI CLINIC OF WAUWATOSA, SC 2805
2500 NORTH MAYFAIR ROAD #600 DAVID DRAJKOWSKI Initial Cert: 09/09/2008 WAUWATOSA, WI 53226 [email protected] Cert Eff: 10/01/2019 County: Milwaukee Phone:(414) 727-4455 Cert Exp: 09/30/2021 Surveyor: Connie Knezic Fax: (414) 727-4690
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
WEST GROVE CLINIC 2318
10012 WEST CAPITOL DRIVE #101 AMY WEST Initial Cert: 06/22/2001 WAUWATOSA, WI 53222 [email protected] Cert Eff: 10/01/2020 County: Milwaukee Phone:(414) 810-4844 Cert Exp: 06/30/2022 Surveyor: Kelley Clark Fax: (414) 810-4845
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 WEST GROVE CLINIC - APPLETON, 47 PARK PLACE, APPLETON, WI 54914 04/01/2021 06/30/2022 1 WEST GROVE CLINIC, 7310 W WELLS ST, WAUWATOSA, WI 53213 10/01/2020 06/30/2022
2 WEST GROVE CLINIC, 1400 75TH ST, KENOSHA, WI 53143 10/01/2020 06/30/2022
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WEST ALLIS AURORA BEHAVIORAL HEALTH CENTER - WEST ALLIS 2397
2424 S 90TH STREET SUITE 502 CARRIE SLOMSKI Initial Cert: 07/12/2002 WEST ALLIS, WI 53227 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 454-6454 Cert Exp: 04/30/2023 Surveyor: Connie Knezic Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA - SIX POINTS CLINIC, 6609 WEST GREENFIELD AVE, WEST ALLIS, WI 53214 05/01/2021 04/30/2023
BROADSTEP WISCONSIN - COMMUNITY SUPPORT PROGRAM 1093
1205 S 70TH STREET, STE 101 KARA STEPHENS Initial Cert: 09/01/1990 WEST ALLIS, WI 53214 [email protected] Cert Eff: 04/01/2021 County: Milwaukee Phone:(414) 303-4985 Cert Exp: 03/31/2023 Surveyor: Kelley Clark Fax: (414) 871-2552
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
MAPLEGROVE TREATMENT CENTER 3026
1455 S 97TH STREET REINA TAKAMURA Initial Cert: 04/08/2014 WEST ALLIS, WI 53214 [email protected] Cert Eff: 11/01/2020 County: Milwaukee Phone:(414) 412-9229 Cert Exp: 10/31/2022 Surveyor: Connie Knezic Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
MIRACLE COUNSELING AND LIFE COACHING LLC 3206
8440 W NATIONAL AVE MIRTA CABRERA Initial Cert: 06/03/2018 WEST ALLIS, WI 53227 [email protected] Cert Eff: 06/01/2021 County: Milwaukee Phone:(414) 405-1682 Cert Exp: 05/31/2023 Surveyor: Connie Knezic Fax: (414) 979-6449
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
PATHWAYS COUNSELING CENTER 1730
11121 W OKLAHOMA AVE DAVID BEDRIN Initial Cert: 12/01/1985 WEST ALLIS, WI 53227 [email protected] Cert Eff: 02/01/2021 County: Milwaukee Phone:(262) 641-9790 Cert Exp: 01/31/2023 Surveyor: Kelley Clark Fax: (262) 641-9791
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 136 of 222 Mental Health Program Directory By County, City, and Provider Name
ROGERS BEHAVIORAL HEALTH - LINCOLN CENTER II 3239
2400 S 102ND ST MAEVE O'NEILL Initial Cert: 08/21/2018 WEST ALLIS, WI 53227 [email protected] Cert Eff: 09/01/2021 County: Milwaukee Phone:(414) 203-4470 Cert Exp: 08/31/2023 Surveyor: Kelley Clark Fax: (262) 303-2007
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL 3032
2448 SOUTH 102ND ST RM #200 MAEVE O'NEILL Initial Cert: 05/01/2014 WEST ALLIS, WI 53227 [email protected] Cert Eff: 05/01/2021 County: Milwaukee Phone:(414) 539-3000 Cert Exp: 04/30/2023 Surveyor: Connie Knezic Fax: (920) 843-5685
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 05/01/2021 04/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL - MILWAUKEE 2214
11101 W. LINCOLN AVENUE MAEVE O'NEILL Initial Cert: 05/01/2000 WEST ALLIS, WI 53227 [email protected] Cert Eff: 08/01/2020 County: Milwaukee Phone:(414) 327-3000 Cert Exp: 04/30/2022 Surveyor: Kelley Clark Fax: (414) 203-4577
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 08/01/2020 04/30/2022 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 08/01/2020 04/30/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 08/01/2020 04/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
STRESS MANAGEMENT & MENTAL HEALTH CLINICS 3204
2514 S 102ND ST STE 275 GREG BUSHMAN Initial Cert: 06/01/2018 WEST ALLIS, WI 53227 [email protected] Cert Eff: 06/01/2021 County: Milwaukee Phone:(414) 329-7000 Cert Exp: 05/31/2023 Surveyor: Connie Knezic Fax: (414) 329-7010
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 137 of 222 Mental Health Program Directory By County, City, and Provider Name
MONROE CASHTON SCENIC BLUFFS COMMUNITY HEALTH CENTERS 2804
238 FRONT STREET KRISTALEE FRANK Initial Cert: 07/28/2008 CASHTON, WI 54619 [email protected] Cert Eff: 10/01/2020 County: Monroe Phone:(608) 654-5100 Cert Exp: 06/30/2022 Surveyor: Roderick Senn Fax: (608) 654-5120
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 SCENIC BLUFFS HLTH CTR INC, 916 FERRY ST, LA CROSSE, WI 54601 10/01/2020 06/30/2022 1 SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 200 W. NORTH STREET, NORWALK, WI 54648 10/01/2020 06/30/2022 1 SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 217 N BLACK RIVER ST, SPARTA, WI 54656 10/01/2020 06/30/2022
Non-Certified School Setting(s) Setting Begin/End Dates ARCADIA ELEMENTARY SCHOOL, 358 RIVER ST, ARCADIA, WI 54612 10/01/2020 06/30/2022 ARCADIA HIGH SCHOOL, 756 RAIDER DR, ARCADIA, WI 54612 10/01/2020 06/30/2022 ARCADIA MIDDLE SCHOOL, 725 FAIRFIELD ST, ARCADIA, WI 54612 10/01/2020 06/30/2022 CASHTON ELEMENTARY SCHOOL, 436 FRONT STREET, CASHTON, WI 54619 10/01/2020 06/30/2022 CASHTON MIDDLE/HIGH SCHOOL, 540 COE STREET, CASHTON, WI 54619 10/01/2020 06/30/2022 LA FARGE HIGH SCHOOL, 301 W ADAMS ST, LA FARGE, WI 54639 10/01/2020 06/30/2022 HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656 10/01/2020 06/30/2022 S.A.I.L..S. CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656 10/01/2020 06/30/2022 KICKAPOO HIGH SCHOOL, S6250 STATE HWY 131, VIOLA, WI 54664 10/01/2020 06/30/2022 VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DR, VIROQUA, WI 54665 10/01/2020 06/30/2022 WESTBY ELEMENTARY, 122 NELSON ST, WESTBY, WI 54667 10/01/2020 06/30/2022
SPARTA MONROE COUNTY COMMUNITY SUPPORT PROGRAM 3277
112 SOUTH COURT ST RM 3000 ALICIA DARLING Initial Cert: 01/02/2020 SPARTA, WI 54656 [email protected] Cert Eff: 01/01/2021 County: Monroe Phone:(608) 269-8684 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (608) 269-8935
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 138 of 222 Mental Health Program Directory By County, City, and Provider Name
MONROE COUNTY DEPARTMENT OF HUMAN SERVICES 1654
112 S COURT ST RM 3000 ALICIA DARLING Initial Cert: 10/01/1975 SPARTA, WI 54656 [email protected] Cert Eff: 01/01/2021 County: Monroe Phone:(608) 269-8684 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (608) 269-8935 Crisis Intervention Services Regional Designation Begin End Lead NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020 TELLURIAN INC CRISIS STABILIZATION SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2021 12/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ROLLING HILLS REHABILITATION CENTER, 14345 COUNTY HWY B, SPARTA, WI 54656 01/07/2021 12/31/2022
09/28/2021 Page 139 of 222 Mental Health Program Directory By County, City, and Provider Name
OCONTO OCONTO BELLIN PSYCHIATRIC CENTER OCONTO HOSPITAL & MEDICAL CENTER 2759
820 ARBUTUS AVENUE ANN MILQUET Initial Cert: 10/23/2007 OCONTO, WI 54153 [email protected] Cert Eff: 11/01/2020 County: Oconto Phone:(920) 431-5642 Cert Exp: 10/31/2022 Surveyor: Renee DeWitt Fax: (920) 437-0533
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/21/2021 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 BELLIN PSYCHIATRIC CENTER-MARINETTE, 2820 ROOSEVELT ROAD, MARINETTE, WI 54143 11/01/2020 10/31/2022
3 GARFIELD ELEMENTARY, 1615 CARNEY BOULEVARD, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 MARINETTE HIGH SCHOOL, 2135 PIERCE AVENUE, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 MARINETTE MIDDLE SCHOOL, 1011 WATER STREET, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 MENEKAUNEE SURISE EARLY LEARNING CENTER, 115 HANCOCK STREET, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 MERRYMAN ELEMENTARY, 611 ELIZABETH AVENUE, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 OUR SAVIOUR'S LUTHERAN CHURCH, 1600 UNIVERSITY DRIVE, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 PARK ELEMENTARY, 1225 HOCKRIDGE STREET, MARINETTE, WI 54143 11/01/2020 10/31/2022 3 OCONTO FALLS - WASHINGTON MIDDLE SCHOOL, 102 S WASHINGTON STREET, OCONTO FALLS, WI 11/01/2020 10/31/2022 54154 3 OCONTO FALLS ELEMENTARY SCHOOL, 415 MARIE VOLK DR, OCONTO FALLS, WI 54154 11/01/2020 10/31/2022 3 OCONTO FALLS HIGH SCHOOL, 210 N FARM ROAD, OCONTO FALLS, WI 54154 11/01/2020 10/31/2022
OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES 1719
501 PARK AVENUE CHRISTOPHER HANKE Initial Cert: 04/01/1979 OCONTO, WI 54153 [email protected] Cert Eff: 09/01/2020 County: Oconto Phone:(920) 834-7000 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (920) 834-6889 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 09/01/2020 08/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 08/31/2022 CSAS-PREVENTION DHS 75.04 09/01/2020 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 08/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2020 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NEW VIEW INDUSTRIES, 164 W PARK STREET, GILLETT, WI 54124 09/01/2020 08/31/2022
09/28/2021 Page 140 of 222 Mental Health Program Directory By County, City, and Provider Name
ONEIDA MINOCQUA LIMBERG & ASSOCIATES, COUNSELING FOR CHANGE 2316
8618 HIGHWAY 51 NORTH SHIRLEY LIMBERG Initial Cert: 03/01/2000 MINOCQUA, WI 54548 [email protected] Cert Eff: 07/01/2020 County: Oneida Phone:(715) 356-6146 Cert Exp: 03/31/2022 Surveyor: Rena Andersen Fax: (715) 358-9556
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 LIMBERG & ASSOCIATES, COUNSELING FOR CHANGE, 1185 S 4TH AVE, PARK FALLS, WI 54552 07/01/2020 03/31/2022
RHINELANDER ASCENSION ST MARY'S INPATIENT BEHAVIORAL HEALTH DEPARTMENT 2515
2251 N SHORE DR #100 JESSICA SCHIEK Initial Cert: 05/01/2004 RHINELANDER, WI 54501 [email protected] Cert Eff: 01/01/2021 County: Oneida Phone:(715) 361-2020 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 361-2021
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 04/30/2022 NO BRANCH LOCATIONS
ASCENSION ST MARYS KOLLER BEHAVIORAL HEALTH 1762
1020 KABEL AVE JESSICA SCHIEK Initial Cert: 06/01/1985 RHINELANDER, WI 54501 [email protected] Cert Eff: 09/01/2020 County: Oneida Phone:(715) 361-2805 Cert Exp: 05/31/2022 Surveyor: Rena Andersen Fax: (715) 361-2920
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2020 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ASCENSION ST MARYS KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI 54520 09/01/2020 05/31/2022 1 ASCENSION ST MARYS KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI 54487 09/01/2020 05/31/2022
2 ASCENSION ST MARYS KOLLER EAGLE RIVER, 930 E WALL STREET, EAGLE RIVER, WI 54521 09/01/2020 05/31/2022 2 ASCENSION ST MARYS KOLLER WOODRUFF, 240 MAPLE STREET, WOODRUFF, WI 54568 09/01/2020 05/31/2022
CORNERSTONE PSYCHOLOGICAL ASSOCIATES LLC 2977
315 S ONEIDA AVE SUITE 101 KRISTINE MARVIN Initial Cert: 08/14/2012 RHINELANDER, WI 54501 [email protected] Cert Eff: 08/01/2021 County: Oneida Phone:(715) 420-1201 Cert Exp: 07/31/2023 Surveyor: Rena Andersen Fax: (715) 420-1202
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 141 of 222 Mental Health Program Directory By County, City, and Provider Name
HARMONY COUNSELING SERVICES LLC DBA TRANSITIONS CENTER 3196
22 N PELHAM ST RITA SEMMERLING Initial Cert: 01/24/2018 RHINELANDER, WI 54501 [email protected] Cert Eff: 01/01/2021 County: Oneida Phone:(715) 365-6696 Cert Exp: 12/31/2022 Surveyor: Rena Andersen Fax: (715) 365-6768
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NICOLET COLLEGE, 5364 COLLEGE DRIVE, RHINELANDER, WI 54501 01/01/2021 12/31/2022
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - RHINELANDER 3188
915 ACACIA LN JACKIE MAURER Initial Cert: 12/04/2017 RHINELANDER, WI 54501 [email protected] Cert Eff: 12/01/2020 County: Oneida Phone:(715) 365-9735 Cert Exp: 11/30/2022 Surveyor: Rena Andersen Fax: (888) 226-8713
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
THE HUMAN SERVICE CENTER 1427
705 EAST TIMBER DRIVE DONNA SHIMECK Initial Cert: 09/01/1980 RHINELANDER, WI 54501 [email protected] Cert Eff: 10/01/2020 County: Oneida Phone:(715) 369-2215 Cert Exp: 09/30/2022 Surveyor: Rena Andersen Fax: (715) 369-2214 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 DHS 51.42 MULTI-COUNTY PROGRAM: FOREST, ONEIDA, VILAS 01/01/2020 FAMILY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 THE HUMAN SERVICE CENTER - FOREST COUNTY BRANCH, 200 E MADISON ST, CRANDON, WI 11/25/2020 09/30/2022 54520 1 THE HUMAN SERVICE CENTER - VILAS COUNTY BRANCH, 330 COURT STREET, EAGLE RIVER, WI 11/25/2020 09/30/2022 54521
THE HUMAN SERVICE CENTER 3043
705 EAST TIMBER DRIVE DONNA SHIMECK Initial Cert: 06/27/2014 RHINELANDER, WI 54501 [email protected] Cert Eff: 10/01/2020 County: Oneida Phone:(715) 369-2215 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 369-2214
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL UNIFIED BOARD DHS 36 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 142 of 222 Mental Health Program Directory By County, City, and Provider Name
THE HUMAN SERVICE CENTER CSP 1426
705 E. TIMBER DRIVE DONNA SHIMECK Initial Cert: 09/01/1980 RHINELANDER, WI 54501 [email protected] Cert Eff: 06/01/2021 County: Oneida Phone:(715) 369-2215 Cert Exp: 05/31/2023 Surveyor: Rena Andersen Fax: (715) 369-2214
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 143 of 222 Mental Health Program Directory By County, City, and Provider Name
OUTAGAMIE APPLETON ASCENSION MEDICAL GROUP BEHAVIORAL HEALTH 2651
1531 S MADISON ST #580 JODIE MCKENZIE Initial Cert: 01/20/2005 APPLETON, WI 54915 [email protected] Cert Eff: 11/01/2019 County: Outagamie Phone:(920) 738-2519 Cert Exp: 10/31/2021 Surveyor: Heather Lom Fax: (920) 730-4924
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2019 11/29/2019
Tier Branch Location(s) Branch Begin/End Dates 2 ASCENSION MED GRP BEH HLTH INTERNAL MED, 1501 S MADISON ST, APPLETON, WI 54915 11/01/2019 10/31/2021 2 ASCENSION MED GRP BEH HLTH RICHMOND ST, 3329 N RICHMOND ST, APPLETON, WI 54911 11/01/2019 10/31/2021 2 ASCENSION MED GRP BEH HLTH NEENAH, 101 MAIN STREET, NEENAH, WI 54956 11/01/2019 10/31/2021 2 ASCENSION MED GRP BEH HLTH KOELLER ST, 1855 S KOELLER, OSHKOSH, WI 54902 11/01/2019 10/31/2021
ASCENSION NE WISCONSIN - ST ELIZABETH CAMPUS 1860
1506 S ONEIDA STREET STEVIE REICH Initial Cert: 02/01/1984 APPLETON, WI 54915 [email protected] Cert Eff: 11/01/2020 County: Outagamie Phone:(920) 738-2930 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 730-5480
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2020 10/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 11/01/2020 10/31/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2020 10/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 144 of 222 Mental Health Program Directory By County, City, and Provider Name
CATALPA HEALTH INC 2984
4635 WEST COLLEGE AVE SCOTT RADTKE Initial Cert: 11/01/2012 APPLETON, WI 54914 [email protected] Cert Eff: 08/01/2020 County: Outagamie Phone:(920) 750-7000 Cert Exp: 10/31/2021 Surveyor: Heather Lom Fax: (920) 882-5495
Services Adm Code Service Begin/End Dates CSAS-PREVENTION DHS 75.04 08/01/2020 10/31/2021 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 08/01/2020 10/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 BOYS AND GIRLS CLUB OF OSHKOSH, 501 E PARKWAY AVENUE, OSHKOSH, WI 54901 08/01/2020 10/31/2021
2 CATALPA HEALTH, 540 N KOELLER ST, OSHKOSH, WI 54902 08/01/2020 10/31/2021 2 CATALPA HEALTH - WAUPACA, 815 WEST FULTON ST, WAUPACA, WI 54981 08/01/2020 10/31/2021
3 HORIZON ELEMENTARY SCHOOL, 2101 SCHAEFER CIRCLE, APPLETON, WI 54915 08/01/2020 10/31/2021 3 JAMES MADISON MIDDLE SCHOOL, 2020 S. CARPENTER STREET, APPLETON, WI 54915 08/01/2020 10/31/2021 3 KALEIDOSCOPE ACADEMY, 318 EAST BREWSTER ST, APPLETON, WI 54911 08/01/2020 10/31/2021 3 BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 308 EAST BURDICK ST, BLACK CREEK, WI 54106 08/01/2020 10/31/2021 3 CHILTON HIGH SCHOOL, 530 W MAIN ST, CHILTON, WI 53014 08/01/2020 10/31/2021 3 CHILTON MIDDLE SCHOOL, 421 COURT ST, CHILTON, WI 53014 08/01/2020 10/31/2021 3 FREEDOM ELEMENTARY SCHOOL, N3569 COUNTY ROAD E, FREEDOM, WI 54913 08/01/2020 10/31/2021 3 FREEDOM HIGH & MIDDLE SCHOOLS, N4021 COUNTY ROAD E, FREEDOM, WI 54913 08/01/2020 10/31/2021 3 GREENVILLE ELEMENTARY SCHOOL, W6822 GREENRIDGE DR., GREENVILLE, WI 54942 08/01/2020 10/31/2021 3 GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR., GREENVILLE, WI 54942 08/01/2020 10/31/2021 3 NORTH GREENVILLE ELEMENTARY SCHOOL, N2468 LEARNING WAY, GREENVILLE, WI 54942 08/01/2020 10/31/2021 3 HILBERT K-12, 1139 W MILWAUKEE ST, HILBERT, WI 54129 08/01/2020 10/31/2021 3 HORTONVILLE ELEMENTARY SCHOOL, 240 WARNER ST., HORTONVILLE, WI 54944 08/01/2020 10/31/2021 3 HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 220, HORTONVILLE, WI 54944 08/01/2020 10/31/2021 3 HORTONVILLE MIDDLE SCHOOL, 220 WARNER ST; PO BOX 359, HORTONVILLE, WI 54944 08/01/2020 10/31/2021 3 BUTTE DES MORTS ELEMENTARY, 501 TAYCO ST, MENASHA, WI 54952 08/01/2020 10/31/2021 3 CLOVIS GROVE ELEMENTARY SCHOOL, 974 9TH ST, MENASHA, WI 54952 08/01/2020 10/31/2021 3 GEGAN ELEMENTARY, 675 AIRPORT RD, MENASHA, WI 54952 08/01/2020 10/31/2021 3 NICOLET ELEMENTARY SCHOOL, 449 AHNAIP ST, MENASHA, WI 54952 08/01/2020 10/31/2021 3 CLAYTON ELEMENTARY SCHOOL, 2916 WEST FAIRVIEW ROAD, NEENAH, WI 54956 08/01/2020 10/31/2021 3 COOLIDGE ELEMENTARY SCHOOL, 321 ALCOTT DRIVE, NEENAH, WI 54956 08/01/2020 10/31/2021 3 HOOVER ELEMENTARY SCHOOL, 950 HUNT AVENUE, NEENAH, WI 54956 08/01/2020 10/31/2021 3 HORACE MANN INTERMEDIATE SCHOOL, 1021 OAK ST, NEENAH, WI 54956 08/01/2020 10/31/2021 3 LAKEVIEW ELEMENTARY SCHOOL, 1645 S. COMMERCIAL ST., NEENAH, WI 54956 08/01/2020 10/31/2021 3 NEENAH HIGH SCHOOL, 1275 TULLAR ROAD, NEENAH, WI 54956 08/01/2020 10/31/2021 3 ROOSEVELT ELEMENTARY SCHOOL, 1645 S COMMERCIAL STREET, NEENAH, WI 54956 08/01/2020 10/31/2021 3 SPRING ROAD ELEMENTARY SCHOOL, 1191 COUNTY ROAD II, NEENAH, WI 54956 08/01/2020 10/31/2021 3 TAFT ELEMENTARY SCHOOL, 133 WESTERN AVENUE, NEENAH, WI 54956 08/01/2020 10/31/2021 3 TULLAR ELEMENTARY SCHOOL, 925 TULLAR ROAD, NEENAH, WI 54956 08/01/2020 10/31/2021 3 WILSON ELEMENTARY SCHOOL, 920 HIGGINS AVENUE, NEENAH, WI 54956 08/01/2020 10/31/2021 3 CARL TRAGER MIDDLE SCHOOL, 3000 W 20TH AVE, OSHKOSH, WI 54904 08/01/2020 10/31/2021 3 JEFFERSON ELEMENTARY SCHOOL, 244 W 11TH AVE, OSHKOSH, WI 54902 08/01/2020 10/31/2021 3 MERRILL MIDDLE SCHOOL, 108 W NEW YORK AVE, OSHKOSH, WI 54901 08/01/2020 10/31/2021 3 OSHKOSH NORTH HIGH SCHOOL, 1100 W. SMITH AVE., OSHKOSH, WI 54901 08/01/2020 10/31/2021 3 OSHKOSH WEST HIGH SCHOOL, 375 N EAGLE ST, OSHKOSH, WI 54902 08/01/2020 10/31/2021 3 PERRY TIPLER MIDDLE SCHOOL, 325 S EAGLE ST, OSHKOSH, WI 54902 08/01/2020 10/31/2021 3 READ ELEMENTARY SCHOOL, 1120 ALGOMA BLVD, OSHKOSH, WI 54901 08/01/2020 10/31/2021 09/28/2021 Page 145 of 222 Mental Health Program Directory By County, City, and Provider Name
3 SOUTH PARK MIDDLE SCHOOL, 1551 DELAWARE ST, OSHKOSH, WI 54902 08/01/2020 10/31/2021 3 WASHINGTON ELEMENTARY SCHOOL, 929 WINNEBAGO AVE, OSHKOSH, WI 54901 08/01/2020 10/31/2021 3 WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI 54901 08/01/2020 10/31/2021 3 ROCKLEDGE INTERMEDIATE CENTER, 330 W HICKORY ST, SEYMOUR, WI 54165 08/01/2020 10/31/2021 3 ROCKLEDGE PRIMARY CENTER, 330 WEST HICKORY ST, SEYMOUR, WI 54165 08/01/2020 10/31/2021 3 SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI 54170 08/01/2020 10/31/2021 3 WAUPACA HIGH SCHOOL, E2325 KING ROAD, WAUPACA, WI 54981 08/01/2020 10/31/2021 3 WAUPACA LEARNING CENTER ELEMENTARY SCHOOL, 1515 SHOEMAKER ROAD, WAUPACA, WI 08/01/2020 10/31/2021 54981 3 WAUPACA MIDDLE SCHOOL, 1149 SHOEMAKER ROAD, WAUPACA, WI 54981 08/01/2020 10/31/2021
LUTHERAN SOCIAL SERVICES 2872
3003 B NORTH RICHMOND ST KATHRYN MATTINGLY Initial Cert: 06/02/2009 APPLETON, WI 54911 [email protected] Cert Eff: 09/01/2021 County: Outagamie Phone:(920) 730-1321 Cert Exp: 08/31/2023 Surveyor: Heather Lom Fax: (920) 734-2824
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 LUTHERAN SOCIAL SERVICES, 1850 CRANSTON ROAD, BELOIT, WI 53511 09/01/2021 08/31/2023
2 LUTHERAN SOCIAL SERVICES OF WI AND UPPER MICHIGAN, 727 8TH STREET, BARABOO, WI 53913 09/01/2021 08/31/2023 2 LUTHERAN SOCIAL SERVICES, 612 N RANDALL AVE, JANESVILLE, WI 53545 09/01/2021 08/31/2023 2 LUTHERAN SOCIAL SERVICES OF WI AND UPPER MICHIGAN, 1904 WINNEBAGO STREET, MADISON, 09/01/2021 08/31/2023 WI 53704
Non-Certified School Setting(s) Setting Begin/End Dates DR. HOWARD FULLER COLLEGIATE ACADEMY, 4030 N 29TH ST., MILWAUKEE, WI 53216 09/01/2021 08/31/2023 LSS-BRUCE-GUADALUPE COMM SCHOOL, 1028 S 9TH ST, MILWAUKEE, WI 53204 09/01/2021 08/31/2023 LSS-BRUCE-GUALALUPE MIDDLE SCHOOL, 920 S 9TH ST, MILWAUKEE, WI 53204 09/01/2021 08/31/2023 MARVIN E PRATT ELEMENTARY, 5131 N GREEN BAY AVE, MILWAUKEE, WI 53209 09/01/2021 08/31/2023 MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN AVE, MILWAUKEE, WI 53233 09/01/2021 08/31/2023 RALPH H METCALFE SCHOOL, 3400 W NORTH AVE, MILWAUKEE, WI 53208 09/01/2021 08/31/2023 SUCCESS CENTER, 3872 N. 8TH ST, MILWAUKEE, WI 53206 09/01/2021 08/31/2023 UCC ACOSTA MIDDLE SCHOOL, 1038 S 6TH ST, MILWAUKEE, WI 53204 09/01/2021 08/31/2023
09/28/2021 Page 146 of 222 Mental Health Program Directory By County, City, and Provider Name
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST DIRECTIONS - APPLETON 2924
442 N. WESTHILL BLVD JACKIE MAURER Initial Cert: 07/26/2010 APPLETON, WI 54914 [email protected] Cert Eff: 05/03/2021 County: Outagamie Phone:(920) 336-8960 Cert Exp: 01/31/2023 Surveyor: Heather Lom Fax: (833) 581-5765
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/03/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 NORTHWEST DIRECTIONS-AMERY, PO BOX 167, 1096 APPLE AVENUE, AMERY, WI 54001 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS-BLACK RIVER FALLS, N6643 COUNTY ROAD A, BLACK RIVER FALLS, WI 05/03/2021 01/31/2023 54615 1 NORTHWEST DIRECTIONS-GREEN BAY, 123 SOUTH VAN BUREN STREET, GREEN BAY, WI 54301 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS-HAYWARD, 10692 U.S. HIGHWAY 63, HAYWARD, WI 54843 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS - MENOMONIE, 402 TECHNOLOGY DR E, MENOMONIE, WI 54751 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS - RHINELANDER, 915 ACACIA LN, RHINELANDER, WI 54501 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS-SIREN, 7670 JOHNSON STREET, SIREN, WI 54872 05/03/2021 01/31/2023 1 NORHTWEST DIRECTIONS-STEVENS POINT, 525 - 4TH AVENUE, STEVENS POINT, WI 54481 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS - MARINER OFFICE, 69 NORTH 28 ST, SUPERIOR, WI 54880 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS-WAUSAU, 5655 N 28TH AVENUE, WAUSAU, WI 54401 05/03/2021 01/31/2023 1 NORTHWEST DIRECTIONS-WISCONSIN RAPIDS, 110-24TH STREET SOUTH, WISCONSIN RAPIDS, WI 05/03/2021 01/31/2023 54494
Non-Certified School Setting(s) Setting Begin/End Dates COLFAX MIDDLE/HIGH SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730 05/03/2021 01/31/2023 MENOMONIE HIGH SCHOOL, 1715 5TH ST W, MENOMONIE, WI 54751 05/03/2021 01/31/2023 MENOMONIE MIDDLE SCHOOL, 920 21ST ST E, MENOMONIE, WI 54751 05/03/2021 01/31/2023 GREAT LAKES ELEMENTARY SCHOOL, 129 N 28TH ST, SUPERIOR, WI 54880 05/03/2021 01/31/2023 NORTHERN LIGHTS ELEMENTARY SCHOOL, 1201 N 28TH ST, SUPERIOR, WI 54880 05/03/2021 01/31/2023
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - APPLETON 2160
442 N. WESTHILL BLVD JACKIE MAURER Initial Cert: 11/01/1999 APPLETON, WI 54914 [email protected] Cert Eff: 05/03/2021 County: Outagamie Phone:(920) 336-8960 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (833) 581-5765
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 05/03/2021 10/31/2022 NO BRANCH LOCATIONS
OPTIONS TREATMENT PROGRAMS INC 2512
1000 N LYNNDALE DRIVE STE C KIMEKO HAGEN Initial Cert: 04/01/2004 APPLETON, WI 54914 [email protected] Cert Eff: 04/01/2020 County: Outagamie Phone:(920) 735-9010 Cert Exp: 03/31/2022 Surveyor: Heather Lom Fax: (920) 735-9050
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
Tier Branch Location(s) Branch Begin/End Dates 2 OPTIONS TREATMENT PROGRAMS, INC., 424 S MONROE AVE #201, GREEN BAY, WI 54301 04/01/2020 03/31/2022 2 OPTIONS TREATMENT PROGRAMS, INC., 922 CHURCHILL ST, WAUPACA, WI 54981 04/01/2020 03/31/2022
09/28/2021 Page 147 of 222 Mental Health Program Directory By County, City, and Provider Name
OUTAGAMIE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP 2314
320 S WALNUT ST RUSS MARMOR Initial Cert: 07/01/1987 APPLETON, WI 54911 [email protected] Cert Eff: 10/01/2020 County: Outagamie Phone:(920) 832-5270 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (920) 832-5488
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
OUTAGAMIE COUNTY DEPT OF HEALTH & HUMAN SERVICES 1724
320 S WALNUT ST BRIAN BEZIER Initial Cert: 07/01/1987 APPLETON, WI 54911 [email protected] Cert Eff: 12/01/2019 County: Outagamie Phone:(920) 832-5270 Cert Exp: 11/30/2021 Surveyor: Heather Lom Fax: (920) 832-4767 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2590
320 S WALNUT ST JUDY VAN RYZIN Initial Cert: 04/01/2005 APPLETON, WI 54911 [email protected] Cert Eff: 04/01/2021 County: Outagamie Phone:(920) 832-5270 Cert Exp: 03/31/2023 Surveyor: Heather Lom Fax: (920) 832-5488
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL - APPLETON 3098
4351 W COLLEGE AVE MAEVE O'NEILL Initial Cert: 09/21/2015 APPLETON, WI 54914 [email protected] Cert Eff: 09/01/2021 County: Outagamie Phone:(262) 646-1397 Cert Exp: 08/31/2022 Surveyor: Renee DeWitt Fax: (920) 843-5685
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 09/01/2021 08/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2022 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2021 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 148 of 222 Mental Health Program Directory By County, City, and Provider Name
SHERMAN COUNSELING MANAGEMENT 2450
W6144 AREOTECH DRIVE DAVID DREWEK Initial Cert: 06/05/2003 APPLETON, WI 54914 [email protected] Cert Eff: 11/01/2020 County: Outagamie Phone:(920) 733-2065 Cert Exp: 05/31/2022 Surveyor: Heather Lom Fax: (920) 733-6565
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 SHERMAN CONSULTING - APPLETON NORTH, 2505 E EVERGREEN DR STE C, APPLETON, WI 54913 11/01/2020 05/31/2022 2 SHERMAN COUNSELING - DELTA CENTER, 196 3RD ST, FOND DU LAC, WI 54935 11/01/2020 05/31/2022 2 SHERMAN COUNSELING - FOND DU LAC, 131 N ROLLING MEADOWS, STE C, FOND DU LAC, WI 11/01/2020 05/31/2022 54937 2 SHERMAN COUNSELING - GREEN BAY, 2270 HOLMGREN WAY, GREEN BAY, WI 54304 11/01/2020 05/31/2022 2 SHERMAN COUNSELING - MANITOWOC, 980 MARITIME DR, STE 6, MANITOWOC, WI 54220 11/01/2020 05/31/2022 2 SHERMAN COUNSELING - OSHKOSH, 222 OHIO STREET, OSHKOSH, WI 54902 11/01/2020 05/31/2022 2 SHERMAN COUNSELING - OSHKOSH, 2370 STATE ROAD 44, #D, OSHKOSH, WI 54904 11/01/2020 05/31/2022
WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS 1997
4351 WEST COLLEGE AVE #410 HANA FOWLES Initial Cert: 05/01/1990 APPLETON, WI 54914 [email protected] Cert Eff: 01/01/2021 County: Outagamie Phone:(800) 438-1772 Cert Exp: 08/31/2022 Surveyor: Heather Lom Fax: (262) 345-5531
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 08/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 3 FOX VALLEY LUTHERAN HS, 5300 N MEADE ST, APPLETON, WI 54913 01/01/2021 08/31/2022 3 WINNEBAGO LUTHERAN ACADEMY, 475 E MERRILL AVE, FOND DU LAC, WI 54935 01/01/2021 08/31/2022 3 MANITOWOC LUTHERAN ACADEMY, 4045 LANCER CIRCLE, MANITOWOC, WI 54220 01/06/2021 08/31/2022 3 NORTHLAND LUTHERAN HS, 2107 TOWER ROAD, MOSINEE, WI 54455 01/01/2021 08/31/2022
09/28/2021 Page 149 of 222 Mental Health Program Directory By County, City, and Provider Name
OZAUKEE CEDARBURG NORTHSHORE CLINIC & CONSULTANTS, INC. 1695
W62 N248 WASHINGTON AVE., #207 JOY MYERS Initial Cert: 10/01/1987 CEDARBURG, WI 53012 [email protected] Cert Eff: 08/01/2021 County: Ozaukee Phone:(262) 375-1116 Cert Exp: 07/31/2023 Surveyor: Connie Knezic Fax: (262) 375-1071
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 NORTHSHORE CLINIC & CONSULTANTS, 207 E BUFFALO STREET, #510, MILWAUKEE, WI 53202 08/01/2021 07/31/2023 2 NORTHSHORE CLINIC & CONSULTANTS, 2363 S 102ND STREET, #203, WEST ALLIS, WI 53227 08/01/2021 07/31/2023 2 NORTHSHORE CLINIC & CONSULTANTS, INC., 1615 BARTON AVENUE, WEST BEND, WI 53090 08/01/2021 07/31/2023
GRAFTON RAVENSWOOD CLINIC 2118
101 FALLS ROAD, 6TH FLOOR ANTHONY F. WERTH, JR. Initial Cert: 06/23/1999 GRAFTON, WI 53024 [email protected] Cert Eff: 09/01/2021 County: Ozaukee Phone:(262) 421-8980 Cert Exp: 08/31/2023 Surveyor: Kelley Clark Fax: (262) 421-8971
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 09/01/2021 08/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS MEQUON AMERICAN BEHAVIORAL CLINICS 2368
1240 W RANCHITO LANE DAVID WINSTON Initial Cert: 05/01/2002 MEQUON, WI 53092 [email protected] Cert Eff: 01/01/2021 County: Ozaukee Phone:(262) 241-3231 Cert Exp: 05/31/2022 Surveyor: Connie Knezic Fax: (262) 241-4311
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #2, 9720 W BLUEMOUND ROAD, MILWAUKEE, WI 01/01/2021 05/31/2022 53226 2 AMERICAN BEHAVIORAL CLINICS-ELM GROVE, 15285 WATERTOWN PLANK ROAD, ELM GROVE, WI 01/01/2021 05/31/2022 53122 2 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #1, 10424 W BLUEMOUND ROAD, MILWAUKEE, WI 01/01/2021 05/31/2022 53226 2 AMERICAN BEHAVIORAL CLINICS-LAYTON, 7330 W LAYTON AVENUE, MILWAUKEE, WI 53220 01/01/2021 05/31/2022
09/28/2021 Page 150 of 222 Mental Health Program Directory By County, City, and Provider Name
ASCENSION COLUMBIA ST MARYS INPATIENT 2507
13111 N PORT WASHINGTON ROAD JASON GAURKEE Initial Cert: 09/02/2003 MEQUON, WI 53097 [email protected] Cert Eff: 03/01/2020 County: Ozaukee Phone:(262) 241-6127 Cert Exp: 02/28/2022 Surveyor: Connie Knezic Fax: (262) 241-6132
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
ASCENSION COLUMBIA ST MARYS OZAUKEE HOSPITAL 1873
13111 N PORT WASHINGTON RD JASON GAURKEE Initial Cert: 09/01/1984 MEQUON, WI 53097 [email protected] Cert Eff: 03/01/2020 County: Ozaukee Phone:(262) 243-7388 Cert Exp: 02/28/2022 Surveyor: Connie Knezic Fax: (262) 243-8380
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2020 02/28/2022 MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2020 02/28/2022 NO BRANCH LOCATIONS PORT WASHINGTON DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY 1276
121 W. MAIN STREET HEATHER CARLSON Initial Cert: 06/01/1977 PORT WASHINGTON, WI 53074 [email protected] Cert Eff: 10/01/2020 County: Ozaukee Phone:(262) 284-8200 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (262) 238-8104 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2020 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
OZAUKEE COUNTY CCS PROGRAM 3050
121 W MAIN STREET HEATHER CARLSON Initial Cert: 09/22/2014 PORT WASHINGTON, WI 53074 [email protected] Cert Eff: 10/01/2020 County: Ozaukee Phone:(262) 284-8200 Cert Exp: 09/30/2022 Surveyor: Connie Knezic Fax: (262) 284-8104
CCS Affiliaton:LAKESHORE RECOVERY COLLABORATIVE V2 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 151 of 222 Mental Health Program Directory By County, City, and Provider Name
OZAUKEE COUNTY CSP 2274
121 W. MAIN STREET HEATHER CARLSON Initial Cert: 06/01/1977 PORT WASHINGTON, WI 53074 [email protected] Cert Eff: 04/01/2021 County: Ozaukee Phone:(262) 238-8200 Cert Exp: 03/31/2023 Surveyor: Connie Knezic Fax: (262) 238-8104
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 152 of 222 Mental Health Program Directory By County, City, and Provider Name
PIERCE ELLSWORTH PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES 1737
412 W KINNE STREET KRISTIE SIMMONS Initial Cert: 12/01/1981 ELLSWORTH, WI 54011 [email protected] Cert Eff: 04/01/2021 County: Pierce Phone:(715) 273-6770 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (715) 273-6862
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 NO BRANCH LOCATIONS
PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES/NORTHWEST CONNECTIONS 2963
412 W. KINNE STREET JULIE RAETHKE Initial Cert: 11/01/2011 ELLSWORTH, WI 54011 [email protected] Cert Eff: 04/01/2021 County: Pierce Phone:(715) 273-6770 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (715) 273-6862 Crisis Intervention Services Regional Designation Begin End Lead HUDSON HOSPITAL CRISIS SERVICES 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS 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
PIERCE COUNTY DEPT OF HUMAN SVS 3020
412 WEST KINNE STREET JOYCE BARKER Initial Cert: 04/01/2014 ELLSWORTH, WI 54011 [email protected] Cert Eff: 04/01/2021 County: Pierce Phone:(715) 273-6770 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (715) 273-6862
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 153 of 222 Mental Health Program Directory By County, City, and Provider Name
POLK AMERY AMERY REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH CENTER 2839
230 DERONDA STREET HEATHER ERICKSON Initial Cert: 12/08/2008 AMERY, WI 54001 [email protected] Cert Eff: 12/01/2019 County: Polk Phone:(715) 268-0060 Cert Exp: 11/30/2021 Surveyor: Rena Andersen Fax: (715) 268-0061
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 CLEAR LAKE CLINIC, 357 THIRD AVENUE, CLEAR LAKE, WI 54005 12/01/2019 11/30/2021 1 LUCK CLINIC, AMERY HOSPITAL AND CLINIC, 2547 STATE ROAD 35, SUITE 1, LUCK, WI 54853 12/01/2019 11/30/2021 1 TURTLE LAKE CLINIC, 550 MARTIN AVENUE, TURTLE LAKE, WI 54889 12/01/2019 11/30/2021
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - AMERY 2195
1096 APPLE AVE JACKIE MAURER Initial Cert: 02/14/2000 AMERY, WI 54001 [email protected] Cert Eff: 02/01/2021 County: Polk Phone:(715) 268-5404 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (888) 625-8641
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 BALSAM LAKE POLK COUNTY BEHAVIORAL HEALTH DEPARTMENT CSP 2222
100 POLK CO PLAZA #180 LISA LAVASSEUR Initial Cert: 01/26/2000 BALSAM LAKE, WI 54810 [email protected] Cert Eff: 01/01/2021 County: Polk Phone:(715) 485-8400 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 485-8450
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 04/30/2022 NO BRANCH LOCATIONS
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POLK COUNTY BEHAVIORAL HEALTH DEPT 2204
100 POLK COUNTY PLAZA #180 LISA LAVASSEUR Initial Cert: 02/08/2000 BALSAM LAKE, WI 54810 [email protected] Cert Eff: 01/01/2021 County: Polk Phone:(715) 485-8400 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 485-8490 Crisis Intervention Services Regional Designation Begin End Lead CHILDRENS SERVICES CRISIS NETWORK 01/01/2020 HUDSON HOSPITAL CRISIS SERVICES 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 04/30/2022 NO BRANCH LOCATIONS FREDERIC NORTHWEST COUNSELING AND GUIDANCE CLINIC 2254
203 UNITED WAY DRIVE ANGELA FREDRICKSON Initial Cert: 08/25/1999 FREDERIC, WI 54837 [email protected] Cert Eff: 02/01/2020 County: Polk Phone:(715) 327-4402 Cert Exp: 01/31/2022 Surveyor: Rena Andersen Fax: (715) 327-4470
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 NORTHWEST PASSAGE RIVERSIDE, 7818 MOLINE RD, PO BOX 349, WEBSTER, WI 54893 02/01/2020 01/31/2022
OSCEOLA PEACE TREE COUNSELING LLC 2792
108 CHIEFTAIN ST STE B VALERIE ZELLMER Initial Cert: 06/24/2008 OSCEOLA, WI 54020 [email protected] Cert Eff: 06/01/2021 County: Polk Phone:(715) 417-3241 Cert Exp: 05/31/2023 Surveyor: Rena Andersen Fax: (715) 417-3243
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 PEACE TREE COUNSELING, LLC, 710 N MAIN STREET #101B, RIVER FALLS, WI 54022 06/01/2021 05/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates FREDERIC ELEMENTARY SCHOOL, 305 BIRCH ST, FREDERIC, WI 54837 06/01/2021 05/31/2023 FREDERIC HIGH SCHOOL, 1437 CLAM FALLS DR, FREDERIC, WI 54837 06/01/2021 05/31/2023 OSCEOLA ELEMENTARY SCHOOL, 250 10TH AVE EAST, OSCEOLA, WI 54020 06/01/2021 05/31/2023 OSCEOLA HIGH SCHOOL, 1111 OAK RIDGE DR, OSCEOLA, WI 54020 06/01/2021 05/31/2023 OSCEOLA INTERMEDIATE SCHOOL, 949 EDUCATION AVE, OSCEOLA, WI 54020 06/01/2021 05/31/2023 OSCEOLA MIDDLE SCHOOL, 1029 OAK RIDGE DR, OSCEOLA, WI 54020 06/01/2021 05/31/2023
09/28/2021 Page 155 of 222 Mental Health Program Directory By County, City, and Provider Name
PORTAGE PLOVER CORNERSTONE CLINIC 3292
2558 POST ROAD DAVE PRINCE Initial Cert: 03/31/2020 PLOVER, WI 54467 [email protected] Cert Eff: 04/01/2021 County: Portage Phone:(715) 600-2798 Cert Exp: 03/31/2023 Surveyor: Heather Lom Fax: (715) 600-5182
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
OSWALD COUNSELING ASSOCIATES 2566
2450 VINEYARD DRIVE LYNNE OSWALD Initial Cert: 01/14/2005 PLOVER, WI 54467 [email protected] Cert Eff: 01/01/2020 County: Portage Phone:(715) 342-0290 Cert Exp: 12/31/2021 Surveyor: Heather Lom Fax: (715) 342-0291
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 NO BRANCH LOCATIONS STEVENS POINT ADVOCATE PSYCHOTHERAPY SERVICES, LLC 3051
3233A BUSINESS PARK DR, STE 304 STEVEN JOHNSON Initial Cert: 10/01/2014 STEVENS POINT, WI 54482 [email protected] Cert Eff: 10/01/2020 County: Portage Phone:(800) 681-2374 Cert Exp: 09/30/2022 Surveyor: Heather Lom Fax: (715) 952-4995
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BOYS & GIRLS CLUB OF PORTAGE CO, 2401 CEDAR DR, PLOVER, WI 54467 10/01/2020 09/30/2021 1 BOYS & GIRLS CLUB OF PORTAGE CO, 941 MICHIGAN AVE, STEVENS POINT, WI 54481 10/01/2020 09/30/2021 1 BOYS AND GIRLS CLUB OF WISC RAPIDS AREA, 501 WEST GRAND AVE, WISCONSIN RAPIDS, WI 10/01/2020 09/30/2021 54495
Non-Certified School Setting(s) Setting Begin/End Dates KENNEDY ELEMENTARY SCHOOL, 616 WEST SECOND STREET, JUNCTION CITY, WI 54443 10/01/2020 09/30/2022 TRI-COUNTY AREA SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 54966 10/01/2020 09/30/2022 HOWE ELEMENTARY SCHOOL, 221 8TH ST N, WISCONSIN RAPIDS, WI 54494 10/01/2020 09/30/2022 MEAD ELEMENTARY CHARTER SCHOOL, 241 - 17TH STREET SOUTH, WISCONSIN RAPIDS, WI 54495 10/01/2020 09/30/2022 WISCONSIN RAPIDS MIDDLE SCHOOL, 1921 27TH AVE S, WISCONSIN RAPIDS, WI 54495 10/01/2020 09/30/2022 WOODSIDE ELEMENTARY SCHOOL, 611 - 2 MILE AVENUE, WISCONSIN RAPIDS, WI 54494 10/01/2020 09/30/2022
09/28/2021 Page 156 of 222 Mental Health Program Directory By County, City, and Provider Name
ASCENSION MEDICAL GROUP - NORTHERN WISCONSIN, INC. 1796
3398 E MARIA DRIVE MARY BEYER Initial Cert: 12/01/1983 STEVENS POINT, WI 54481 [email protected] Cert Eff: 01/01/2020 County: Portage Phone:(715) 341-7441 Cert Exp: 12/31/2021 Surveyor: Heather Lom Fax: (715) 343-2088
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 ASCENSION MED GRP PSYCHIATRY DEPT, 122 WILSHIRE BLVD NORTH BLDG 2, STEVENS POINT, 01/01/2020 12/31/2021 WI 54481 3 BANNACH ELEMENTARY SCHOOL, 5400 WALTER STREET, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 3 PJ JACOBS JUNIOR HIGH SCHOOL, 2400 MAIN ST, STEVENS POINT, WI 54481 01/08/2020 12/31/2021 3 STEVENS POINT AREA SENIOR HIGH, 1201 NORTHPOINT DR, STEVENS POINT, WI 54481 01/01/2020 12/31/2021 3 WASHINGTON ELEMENTARY, 3500 PRAIS STREET, STEVENS POINT, WI 54481 01/01/2020 12/31/2021
ASCENSION ST MICHAELS BEHAVIORAL HEALTH 1217
209 PRENTICE ST N LAURIE ROBERTS Initial Cert: 05/01/1991 STEVENS POINT, WI 54481 [email protected] Cert Eff: 07/01/2021 County: Portage Phone:(715) 344-4611 Cert Exp: 06/30/2023 Surveyor: Heather Lom Fax: (715) 344-8127
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 ASCENSION ST MICHAELS BEHAVIORAL HEALTH, 190 GRAND SEASONS DR, WAUPACA, WI 54981 07/01/2021 06/30/2023
ASCENSION ST MICHAELS BEHAVIORAL HEALTH 1820
900 ILLINOIS AVE LAURIE ROBERTS Initial Cert: 05/01/1978 STEVENS POINT, WI 54481 [email protected] Cert Eff: 10/01/2021 County: Portage Phone:(715) 346-5400 Cert Exp: 09/30/2023 Surveyor: Heather Lom Fax: (715) 346-5571
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2021 09/30/2023 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 157 of 222 Mental Health Program Directory By County, City, and Provider Name
NEW DIRECTIONS COUNSELING CENTER, LLC 1662
5541 HWY 10 EAST, SUITE B DIANE DICKINSON Initial Cert: 09/16/1996 STEVENS POINT, WI 54482 [email protected] Cert Eff: 09/01/2020 County: Portage Phone:(715) 345-9690 Cert Exp: 05/31/2022 Surveyor: Heather Lom Fax: (715) 345-2938
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BOYS & GIRLS CLUB OF PORTAGE CO, 941 MICHIGAN AVE, STEVENS POINT, WI 54481 09/01/2020 05/31/2022 1 NEW DIRECTIONS COUNSELING CENTER, N2919 COUNTY RD QQ, WAUPACA, WI 54981 09/01/2020 05/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ROOSEVELT IDEA ELEMENTARY SCHOOL, 2200 WISCONSIN AVE, PLOVER, WI 54467 09/01/2020 05/31/2022 BEN FRANKLIN JR HIGH, 2000 POLK ST, STEVENS POINT, WI 54481 09/01/2020 05/31/2022 PJ JACOBS JUNIOR HIGH SCHOOL, 2400 MAIN ST, STEVENS POINT, WI 54481 09/01/2020 05/31/2022 PLOVER-WHITING ELEMENTARY SCHOOL, 1400 HOOVER AVENUE, WAUPACA, WI 54981 09/01/2020 05/31/2022 WAUPACA LEARNING CENTER, 1515 SHOEMAKER ROAD, WAUPACA, WI 54981 09/01/2020 05/31/2022 WAUPACA MIDDLE SCHOOL, 515 SHOEMAKER ROAD, WAUPACA, WI 54981 09/01/2020 05/31/2022
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - STEVENS POINT 2405
931 MICHIGAN AVE STE 101 JACKIE MAURER Initial Cert: 10/14/2002 STEVENS POINT, WI 54481 [email protected] Cert Eff: 02/01/2021 County: Portage Phone:(715) 997-9486 Cert Exp: 01/31/2023 Surveyor: Heather Lom Fax: (844) 810-8859
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
POINT COUNSELING CENTER LLC 3289
1547 STRONGS AVE STE D KATHRYN GOEL Initial Cert: 02/13/2020 STEVENS POINT, WI 54481 [email protected] Cert Eff: 02/01/2021 County: Portage Phone:(715) 303-2900 Cert Exp: 01/31/2023 Surveyor: Heather Lom Fax: (715) 303-2928
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 158 of 222 Mental Health Program Directory By County, City, and Provider Name
PORTAGE COUNTY HEALTH & HUMAN SERVICES 1740
817 WHITING AVENUE JESSICA HAKE Initial Cert: 06/01/1976 STEVENS POINT, WI 54481 [email protected] Cert Eff: 04/01/2021 County: Portage Phone:(715) 345-5350 Cert Exp: 03/31/2023 Surveyor: Heather Lom Fax: (715) 345-5966 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 FAMILY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-INTERVENTION DHS 75.16 04/01/2021 03/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2712
817 WHITING AVENUE JESSICA HAKE Initial Cert: 03/01/2007 STEVENS POINT, WI 54481 [email protected] Cert Eff: 03/01/2021 County: Portage Phone:(715) 345-5350 Cert Exp: 02/28/2023 Surveyor: Heather Lom Fax: (715) 345-5966
CCS Affiliaton:PORTAGE WOOD PARTNERSHIP Begin: 09/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
09/28/2021 Page 159 of 222 Mental Health Program Directory By County, City, and Provider Name
PRICE PHILLIPS ACCESS, INC 3256
171 CHESTNUT ST TERRI BOLLINGER Initial Cert: 05/01/2019 PHILLIPS, WI 54555 [email protected] Cert Eff: 08/01/2020 County: Price Phone:(715) 563-7776 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 235-2688
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
PRICE COUNTY HEALTH & HUMAN SERVICES/AURORA 2644
104 S EYDER SARAH REESE-SOCHA Initial Cert: 02/01/2006 PHILLIPS, WI 54555 [email protected] Cert Eff: 02/01/2021 County: Price Phone:(715) 339-2158 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (715) 339-4018 Crisis Intervention Services Regional Designation Begin End Lead ASHLAND COUNTY SHARED CRISIS STABILIZATION SERVICE 01/01/2020 AURORA COMMUNITY SERVICES SHARED CALL SERVICE 01/01/2020 COLLABORATIVE CRISIS INTERVENTION SERVICES TO YOUTH 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
SERENE COUNSELING LLC 3294
148 SOUTH AVON AVE ANNA CHILDS Initial Cert: 05/28/2020 PHILLIPS, WI 54555 [email protected] Cert Eff: 05/28/2020 County: Price Phone:(715) 663-0717 Cert Exp: 06/30/2021 Surveyor: Rena Andersen Fax: () -
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/28/2020 06/30/2021
Non-Certified School Setting(s) Setting Begin/End Dates PHILLIPS HIGH SCHOOL, 300 CHERRY ST, PHILLIPS, WI 54555 09/07/2020 06/30/2021
09/28/2021 Page 160 of 222 Mental Health Program Directory By County, City, and Provider Name
RACINE BURLINGTON AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES 1089
116 DODGE ST SUITE 3 DONALD NEUMANN Initial Cert: 10/01/1983 BURLINGTON, WI 53105 [email protected] Cert Eff: 02/01/2021 County: Racine Phone:(262) 763-7766 Cert Exp: 01/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 763-9326
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA MED GROUP BEHAV HLTH-WATERFORD, 818 FORREST, WATERFORD, WI 53185 02/01/2021 01/31/2023
CLINICAL PSYCH ASSOCIATES, LLC 1206
197 W CHESTNUT ST, STE 100 DAVID W THOMPSON PHD Initial Cert: 03/01/1993 BURLINGTON, WI 53105 [email protected] Cert Eff: 06/15/2020 County: Racine Phone:(262) 763-9191 Cert Exp: 03/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 763-7767
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/15/2020 03/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BURLINGTON HIGH SCHOOL, 4000 MCCANNA PKWY, BURLINGTON, WI 53105 06/15/2020 03/31/2022 DYER INTERMEDIATE SCHOOL, 201 S KENDRICK AVE, BURLINGTON, WI 53105 06/15/2020 03/31/2022 KARCHER MIDDLE SCHOOL, 225 ROBERT ST, BURLINGTON, WI 53105 06/15/2020 03/31/2022 LYONS CENTER ELEMENTARY, 1622 MILL ST, BURLINGTON, WI 53105 06/15/2020 03/31/2022 SO LAKES CONSORTIUM ALT HIGH, 209 WAINWRIGHT AVE, BURLINGTON, WI 53105 06/15/2020 03/31/2022 DROUGHT SCHOOL, 21016 W 7 MILE ROAD, FRANKSVILLE, WI 53126 06/15/2020 03/31/2022 FOX RIVER MIDDLE SCHOOL, 921 W MAIN ST, WATERFORD, WI 53185 06/15/2020 03/31/2022 WOODFIELD ELEMENTARY SCHOOL, 905 BARNES DR, WATERFORD, WI 53185 06/15/2020 03/31/2022
09/28/2021 Page 161 of 222 Mental Health Program Directory By County, City, and Provider Name
RACINE ASCENSION ALL SAINTS MENTAL HEALTH & ADDICTION CARE 1027
1320 WISCONSIN AVENUE STACEY YONKOSKI Initial Cert: 07/01/1990 RACINE, WI 53403 [email protected] Cert Eff: 07/01/2021 County: Racine Phone:(262) 687-2722 Cert Exp: 06/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 687-2802
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 07/01/2021 06/30/2022 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2021 06/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2022 MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 07/01/2021 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 07/01/2021 06/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2021 06/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2021 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ASCENSION ALL SAINTS - CARDIAC REHAB, 3803 SPRING ST, RACINE, WI 53405 07/01/2021 06/30/2022
2 AHCMP, 10180 WASHINGTON AVE, MOUNT PLEASANT, WI 53177 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - MT PLEASANT, 4328 OLD GREEN BAY RD, MOUNT PLEASANT, WI 53403 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - OAK CREEK, 8020 S HOWELL AVE, OAK CREEK, WI 53154 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - FAMILY MEDICINE, 1320 WISCONSIN AVE, RACINE, WI 53403 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - FOUR MILE, 2408 FOUR MILE ROAD, RACINE, WI 53402 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - NEUROLOGY, 3805B SPRING ST 3RD FLOOR, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - ONCOLOGY, 3809 SPRING ST, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - SLHP, 3821 SPRING ST, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - SUITE 20, 3805B SPRING ST LL-20, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - SUITE 240, 3805B SPRING ST #240, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - SUITE 340, 3805B SPRING ST #340, RACINE, WI 53405 07/01/2021 06/30/2022 2 ASCENSION ALL SAINTS - UNION GROVE, 1120 MAIN ST, UNION GROVE, WI 53182 07/01/2021 06/30/2022
BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY 2976
1717 TAYLOR AVE MICHELLE GOGGINS Initial Cert: 08/02/2012 RACINE, WI 53403 [email protected] Cert Eff: 08/01/2021 County: Racine Phone:(262) 638-6744 Cert Exp: 07/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 638-6540
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2021 07/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2021 07/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 162 of 222 Mental Health Program Directory By County, City, and Provider Name
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. 1135
800 WISCONSIN AVE RICARDO CISNEROS Initial Cert: 06/01/1981 RACINE, WI 53403 [email protected] Cert Eff: 04/01/2021 County: Racine Phone:(414) 769-3415 Cert Exp: 06/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 637-0695
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 CATHOLIC CHARITIES - KENOSHA, 7117 14TH AVE, KENOSHA, WI 53143 04/01/2021 06/30/2022
CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1180
8800 WASHINGTON AVE, SUITE 100 EDEN CHRISTMAN Initial Cert: 10/01/1984 RACINE, WI 53406 [email protected] Cert Eff: 10/01/2021 County: Racine Phone:(262) 633-3591 Cert Exp: 09/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 633-2619
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 2 CSSW - BURLINGTON, 480 S PINE, BURLINGTON, WI 53105 10/01/2021 09/30/2023
Non-Certified School Setting(s) Setting Begin/End Dates BULL EARLY LEARNING SCHOOL, 815 DE KOVEN AVE, RACINE, WI 53403 10/01/2021 09/30/2023 FRATT ELEMENTARY SCHOOL, 3501 KINZIE AVE, RACINE, WI 53405 10/01/2021 09/30/2023 GIFFORD K-8, 8332 NORTHWESTERN AVE, RACINE, WI 53406 10/01/2021 09/30/2023 JERSTAD-AGERHOLM K-8, 3535 LASALLE ST, RACINE, WI 53402 10/01/2021 09/30/2023 JULIAN THOMAS ELEMENTARY SCHOOL, 930 DR MARTIN LUTHER KING DR, RACINE, WI 53404 10/01/2021 09/30/2023 KNAPP ELEMENTARY SCHOOL, 2701 17TH ST, RACINE, WI 53405 10/01/2021 09/30/2023 MITCHELL K-8, 2701 DREXEL AVE, RACINE, WI 53405 10/01/2021 09/30/2023 SC JOHNSON ELEMENTARY SCHOOL, 2420 KENTUCKY ST, RACINE, WI 53404 10/01/2021 09/30/2023 WADEWITZ ELEMENTARY SCHOOL, 2700 YOUT ST, RACINE, WI 53404 10/01/2021 09/30/2023
DEROSE FAMILY COUNSELING LLC 2958
316 5TH STREET SUITE 1 TALIA DEROSE Initial Cert: 03/07/2012 RACINE, WI 53403 [email protected] Cert Eff: 04/01/2021 County: Racine Phone:(262) 633-1235 Cert Exp: 03/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 633-1236
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
FAMILY SERVICE OF RACINE, INC. 1339
420 SEVENTH STREET EMILY LOCK Initial Cert: 11/01/1983 RACINE, WI 53403 [email protected] Cert Eff: 01/01/2021 County: Racine Phone:(262) 634-2391 Cert Exp: 12/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 634-5342
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 163 of 222 Mental Health Program Directory By County, City, and Provider Name
LAKESIDE FAMILY THERAPY SERVICES, LTD 3212
4810 NORTHWESTERN AVE JACQUELINE V MCRAE Initial Cert: 07/02/2018 RACINE, WI 53406 [email protected] Cert Eff: 08/01/2019 County: Racine Phone:(262) 637-9984 Cert Exp: 07/31/2021 Surveyor: Anastasia E. Vega Fax: (262) 637-9995
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2019 07/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021
Tier Branch Location(s) Branch Begin/End Dates 2 LFTS LTD, KENOSHA, 2221 63RD AVE, KENOSHA, WI 53143 02/24/2020 07/31/2021 2 LFTS LTD, RACINE MONUMENT SQUARE, 524 MONUMENT SQUARE, RACINE, WI 53403 02/24/2020 07/31/2021
PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC LLC 2773
5801 WASHINGTON AVENUE, #110 ALICE PORTIS-PATTERSON Initial Cert: 02/05/2008 RACINE, WI 53406 [email protected] Cert Eff: 06/01/2021 County: Racine Phone:(262) 884-9734 Cert Exp: 02/28/2023 Surveyor: Anastasia E. Vega Fax: (262) 884-9735
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 02/28/2023 NO BRANCH LOCATIONS
RACINE COUNTY CCS 3031
1717 TAYLOR AVE MICHELLE GOGGINS Initial Cert: 05/08/2014 RACINE, WI 53403 [email protected] Cert Eff: 06/01/2021 County: Racine Phone:(262) 638-6633 Cert Exp: 05/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 638-6983
CCS Affiliaton:KENOSHA RACINE REGIONAL CONSORTIUM (KRRC) Begin: 12/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
RACINE COUNTY HUMAN SERVICES DEPARTMENT 2490
1717 TAYLOR AVENUE MICHELLE GOGGINS Initial Cert: 01/14/2004 RACINE, WI 53403 [email protected] Cert Eff: 07/01/2021 County: Racine Phone:(262) 638-6633 Cert Exp: 11/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 638-6983 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2021 11/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 164 of 222 Mental Health Program Directory By County, City, and Provider Name
RACINE COUNTY HUMAN SERVICES DEPARTMENT COMMUNITY SUPPORT PROGRAM 2952
1717 TAYLOR AVENUE MICHELLE GOGGINS Initial Cert: 12/01/2011 RACINE, WI 53403 [email protected] Cert Eff: 06/01/2021 County: Racine Phone:(262) 638-6633 Cert Exp: 11/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 638-6983
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2021 11/30/2022 NO BRANCH LOCATIONS STURTEVANT PSYCHIATRIC SERVICES OF RACINE 1757
8700 DURAND AVE #600 PATTI ROGINSKI Initial Cert: 05/01/1988 STURTEVANT, WI 53177 [email protected] Cert Eff: 05/01/2021 County: Racine Phone:(262) 635-5520 Cert Exp: 10/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 635-5530
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 10/31/2022 NO BRANCH LOCATIONS WATERFORD LAKEVIEW CARE PARTNERS WISCONSIN 2934
1701 SHARP ROAD DR. CYNTHIA SORENSON Initial Cert: 02/14/2011 WATERFORD, WI 53185 [email protected] Cert Eff: 02/01/2021 County: Racine Phone:(262) 534-8565 Cert Exp: 01/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 534-8553
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 165 of 222 Mental Health Program Directory By County, City, and Provider Name
RICHLAND RICHLAND CENTER PINE COUNSELING INC 3267
204 S ORANGE ST ELIJAH J KRAMER Initial Cert: 11/13/2019 RICHLAND CENTER, WI 53581 [email protected] Cert Eff: 12/01/2020 County: Richland Phone:(608) 383-1261 Cert Exp: 11/30/2022 Surveyor: Tina Dary Fax: (608) 383-1348
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2020 11/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
RICHLAND COUNTY HEALTH & HUMAN SERVICES 1797
221 W SEMINARY STREET MYRANDA CULVER Initial Cert: 01/01/1988 RICHLAND CENTER, WI 53581 [email protected] Cert Eff: 02/01/2020 County: Richland Phone:(608) 647-8821 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 647-6611 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 HOME YOUTH DIVERSION PROGRAM 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2020 01/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2020 01/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2020 01/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates DOUDNA ELEMENTARY SCHOOL, 1990 BOHMANN DR, RICHLAND CENTER, WI 53581 02/01/2020 01/31/2022 JEFFERSON ELEMENTARY SCHOOL, 586 N MAIN ST, RICHLAND CENTER, WI 53581 02/01/2020 01/31/2022 RICHLAND CENTER HIGH SCHOOL, 1996 US HWY 14, RICHLAND CENTER, WI 53581 02/01/2020 01/31/2022 RICHLAND MIDDLE SCHOOL, 1801 WI HWY 80 S, RICHLAND CENTER, WI 53581 02/01/2020 01/31/2022
RICHLAND COUNTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2563
221 W SEMINARY STREET MYRANDA CULVER Initial Cert: 01/01/2005 RICHLAND CENTER, WI 53581 [email protected] Cert Eff: 02/01/2020 County: Richland Phone:(608) 647-8821 Cert Exp: 01/31/2022 Surveyor: Tina Dary Fax: (608) 647-6611
CCS Affiliaton:WISCONSIN RIVER CCS COLLABORATION Begin: 07/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 166 of 222 Mental Health Program Directory By County, City, and Provider Name
ROCK BELOIT BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER 1100
1969 W HART ROAD LAURA NEECE Initial Cert: 07/01/1985 BELOIT, WI 53511 [email protected] Cert Eff: 12/01/2020 County: Rock Phone:(608) 364-5686 Cert Exp: 11/30/2022 Surveyor: Anastasia E. Vega Fax: (608) 363-5756
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI 53511 12/01/2020 11/30/2022 1 JANESVILLE CLINIC, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI 53545 12/01/2020 11/30/2022
3 CCC - BELOIT LEARNING ACADEMY, 1033 WOODWARD AVE, BELOIT, WI 53511 12/01/2020 11/30/2022 3 CCC - BELOIT MEMORIAL HIGH SCHOOL, 1225 4TH STREET, BELOIT, WI 53511 12/01/2020 11/30/2022
COMMUNITY HEALTH SYSTEM BEHAVIORAL HEALTH 3190
74 ECLIPSE CENTER MILLER D KNIGHT Initial Cert: 02/01/2018 BELOIT, WI 53511 [email protected] Cert Eff: 02/01/2020 County: Rock Phone:(608) 313-3372 Cert Exp: 01/31/2022 Surveyor: Anastasia E. Vega Fax: (608) 313-3119
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 01/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
FAMILY SERVICES OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INC. 1331
416 COLLEGE STREET JENIFER JELINEK Initial Cert: 06/01/1981 BELOIT, WI 53511 [email protected] Cert Eff: 06/01/2021 County: Rock Phone:(608) 365-1244 Cert Exp: 05/31/2023 Surveyor: Anastasia E. Vega Fax: (608) 365-4097
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
ROCK COUNTY HUMAN SERVICES DEPARTMENT - BELOIT COMMUNITY SUPPORT PROGRAM 1804
64 ECLIPSE CENTER AMY COTTINGTON Initial Cert: 09/01/1989 BELOIT, WI 53511 [email protected] Cert Eff: 05/01/2021 County: Rock Phone:(608) 363-6200 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (608) 363-6392
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 167 of 222 Mental Health Program Directory By County, City, and Provider Name
JANESVILLE ASSOCIATES IN PSYCHOTHERAPY, LLC 1075
4700 DRESSER DRIVE STE #100 DEBBIE STEFFENSEN Initial Cert: 08/01/1980 JANESVILLE, WI 53546 [email protected] Cert Eff: 01/01/2021 County: Rock Phone:(608) 752-7255 Cert Exp: 05/31/2022 Surveyor: Anastasia E. Vega Fax: (608) 752-6942
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022 NO BRANCH LOCATIONS
COMPASS BEHAVIORAL HEALTH CLINIC, A DIVISION OF RVCP 1809
203 W SUNNY LANE ROAD ANGEL EGGERS Initial Cert: 03/01/1990 JANESVILLE, WI 53546 [email protected] Cert Eff: 03/01/2020 County: Rock Phone:(608) 741-4500 Cert Exp: 02/28/2022 Surveyor: Anastasia E. Vega Fax: (608) 741-4502
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 03/01/2020 02/28/2022 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 08/26/2021 02/28/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/26/2021 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 2 COMPASS BEHAVIORAL HEALTH CLINIC, 1820 CENTER AVE #170, JANESVILLE, WI 53546 03/01/2020 02/28/2022
GENESIS COUNSELING SERVICES LTD 1381
ONE S MAIN STREET JAMES BURNS Initial Cert: 07/01/1988 JANESVILLE, WI 53545 [email protected] Cert Eff: 04/01/2021 County: Rock Phone:(608) 757-0404 Cert Exp: 06/30/2022 Surveyor: Anastasia E. Vega Fax: (608) 757-2319
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 06/30/2022 NO BRANCH LOCATIONS
MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM 3002
903 MINERAL POINT AVENUE LISA USGAARD Initial Cert: 05/18/2013 JANESVILLE, WI 53548 [email protected] Cert Eff: 07/01/2021 County: Rock Phone:(608) 756-5555 Cert Exp: 06/30/2023 Surveyor: Anastasia E. Vega Fax: (608) 756-6564
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 07/01/2021 06/30/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 168 of 222 Mental Health Program Directory By County, City, and Provider Name
MERCY OPTIONS - MERCY HEALTH SYSTEMS 1612
1000 MINERAL POINT AVE ANN BUNNELL Initial Cert: 10/01/1984 JANESVILLE, WI 53548 [email protected] Cert Eff: 07/01/2021 County: Rock Phone:(608) 756-6508 Cert Exp: 06/30/2023 Surveyor: Anastasia E. Vega Fax: (608) 741-6962
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2021 06/30/2023 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE 1610
903 MINERAL POINT ROAD MICHELLE ROSE-BARAJAS Initial Cert: 01/01/1993 JANESVILLE, WI 53548 [email protected] Cert Eff: 01/01/2020 County: Rock Phone:(608) 756-5555 Cert Exp: 12/31/2021 Surveyor: Anastasia E. Vega Fax: (608) 756-0174
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 MERCY CLINIC NORTH, 3400 DEERFIELD DRIVE, JANESVILLE, WI 53546 01/01/2020 12/31/2021 1 MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI 53545 01/01/2020 12/31/2021
2 MERCY BELOIT CLINIC, 2825 PRAIRIE AVENUE, BELOIT, WI 53511 01/01/2020 12/31/2021 2 MERCY EVANSVILLE CLINIC, 300 UNION STREET, EVANSVILLE, WI 53536 01/01/2020 12/31/2021 2 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MERCYCARE, 580 N. WASHINGTON ST., 01/01/2020 12/31/2021 JANESVILLE, WI 53548 2 MERCY OPTIONS BH CLINIC - WALWORTH, N2846 STATE ROAD 67, WILLIAMS BAY, WI 53191 01/01/2020 12/31/2021
3 CRAIG HIGH SCHOOL, 401 RANDALL AVENUE, JANESVILLE, WI 53545 01/07/2020 12/31/2021 3 MILTON HIGH SCHOOL, 114 W HIGH STREET, MILTON, WI 53563 01/07/2020 12/31/2021 3 MILTON MIDDLE SCHOOL, 448 E HIGH STREET, MILTON, WI 53563 01/07/2020 12/31/2021 3 NORTHSIDE INTERMEDIATE SCHOOL, 159 NORTHSIDE DRIVE, MILTON, WI 53563 01/07/2020 12/31/2021
Non-Certified School Setting(s) Setting Begin/End Dates PARKER HIGH SCHOOL, 3125 MINERAL POINT AVE, JANESVILLE, WI 53548 01/01/2020 12/31/2021 WILSON ELEMENTARY SCHOOL, 465 ROCKPORT ROAD, JANESVILLE, WI 53548 01/01/2020 12/31/2021
MERCY OPTIONS CHILD AND ADOLESCENT DAY TREATMENT 2741
2600 HUMES RD, SUITE 100 LISA USGAARD Initial Cert: 07/01/2007 JANESVILLE, WI 53545 [email protected] Cert Eff: 07/01/2021 County: Rock Phone:(608) 741-2117 Cert Exp: 06/30/2023 Surveyor: Anastasia E. Vega Fax: (608) 758-5761
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 169 of 222 Mental Health Program Directory By County, City, and Provider Name
ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES 3030
1717 CENTER AVE JENNA SINGER Initial Cert: 07/01/2014 JANESVILLE, WI 53546 [email protected] Cert Eff: 09/01/2021 County: Rock Phone:(608) 741-3500 Cert Exp: 06/30/2022 Surveyor: Anastasia E. Vega Fax: (608) 757-5545
CCS Affiliaton:JRW TRI COUNTY REGIONAL CCS Begin: 08/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2021 06/30/2022 NO BRANCH LOCATIONS
ROCK COUNTY COUNSELING CENTER 1807
1717 CENTER AVE BETTE TRIMBLE Initial Cert: 10/01/1975 JANESVILLE, WI 53546 [email protected] Cert Eff: 09/01/2021 County: Rock Phone:(608) 757-5850 Cert Exp: 08/31/2022 Surveyor: Anastasia E. Vega Fax: (608) 757-5545
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 ROCK COUTNY JOB CENTER, 1900 CENTER AVENUE, JANESVILLE, WI 53546 09/01/2021 08/31/2022
2 ROCK CNTY CNSLNG CTR - BELOIT BRANCH, 64 ECLIPSE CENTER, BELOIT, WI 53511 09/01/2021 08/31/2022 2 COURT STREET BRANCH OFFICE, 303 W. COURT ST., JANESVILLE, WI 53548 09/01/2021 08/31/2022 2 ROCK CNTY CNSLNG CTR - HEALTHCARE CTR BRANCH, 3530 N COUNTY TRK HWY F, JANESVILLE, 09/01/2021 08/31/2022 WI 53547
ROCK COUNTY HUMAN SERVICES CRISIS INTERVENTION UNIT 1803
1717 CENTER AVE BETTE TRIMBLE Initial Cert: 01/10/1975 JANESVILLE, WI 53546 [email protected] Cert Eff: 09/01/2021 County: Rock Phone:(608) 757-5025 Cert Exp: 08/31/2022 Surveyor: Anastasia E. Vega Fax: (608) 758-8435 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2021 08/31/2022 NO BRANCH LOCATIONS
ROCK COUNTY HUMAN SERVICES DEPT JANESVILLE COMMUNITY SUPPORT PROGRAM 1805
1717 CENTER AVE AMY COTTINGTON Initial Cert: 09/01/1989 JANESVILLE, WI 53546 [email protected] Cert Eff: 09/01/2021 County: Rock Phone:(608) 757-5566 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (608) 757-5545
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2021 04/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 170 of 222 Mental Health Program Directory By County, City, and Provider Name
TRIVIUM DBA CROSSROADS COUNSELING CENTER 1265
17 S RIVER STREET #254 TIM PERRY Initial Cert: 09/01/1977 JANESVILLE, WI 53548 [email protected] Cert Eff: 12/29/2020 County: Rock Phone:(608) 755-5260 Cert Exp: 09/30/2021 Surveyor: Anastasia E. Vega Fax: (608) 755-5267
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/29/2020 09/30/2021 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 12/29/2020 09/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/29/2020 09/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 CROSSROADS COUNSELING CENTER, 722-728 LOIS DRIVE, SUN PRAIRIE, WI 53590 12/29/2020 09/30/2021
09/28/2021 Page 171 of 222 Mental Health Program Directory By County, City, and Provider Name
RUSK LADYSMITH ACCESS, INC COMMUNITY SUPPORT PROGRAM 2948
108 W 2ND STREET N TERRI BOLLINGER Initial Cert: 09/06/2011 LADYSMITH, WI 54848 [email protected] Cert Eff: 09/01/2021 County: Rusk Phone:(715) 563-7776 Cert Exp: 08/31/2023 Surveyor: Rena Andersen Fax: (715) 532-9774
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
RUSK COUNTY HEALTH & HUMAN SERVICES/ACCESS, INC. 2691
311 E MINER AVENUE JEREMY JACOBS Initial Cert: 05/16/2006 LADYSMITH, WI 54848 [email protected] Cert Eff: 08/01/2020 County: Rusk Phone:(715) 532-2299 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 532-2126 Crisis Intervention Services Regional Designation Begin End Lead AURORA COMMUNITY SERVICES SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 172 of 222 Mental Health Program Directory By County, City, and Provider Name
SAINT CROIX BALDWIN WESTERN WISCONSIN HEALTH - BEHAVIORAL HEALTH SERVICES 2946
1100 BERGSLIEN STREET EMILY DUCH Initial Cert: 07/20/2011 BALDWIN, WI 54002 [email protected] Cert Eff: 10/01/2020 County: Saint Croix Phone:(715) 684-1510 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 684-1524
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 BALDWIN - WOODVILLE HIGH SCHOOL, 1000 13TH AVENUE, BALDWIN, WI 54002 10/01/2020 06/30/2022 3 GREENFIELD ELEMENTARY SCHOOL, 1160 14TH AVENUE, BALDWIN, WI 54002 10/01/2020 06/30/2022 3 ELMWOOD K-12, 213 S SCOTT STREET, ELMWOOD, WI 54740 10/26/2020 06/30/2022 3 PLUM CITY ELEMENTARY, 621 MAIN STREET, PLUM CITY, WI 54761 10/26/2020 06/30/2022 3 PLUM CITY MIDDLE/HIGH, 907 MAIN STREET, PLUM CITY, WI 54761 10/26/2020 06/30/2022 3 SPRING VALLEY ELEMENTARY, 200 SABIN AVE, SPRING VALLEY, WI 54767 10/26/2020 06/30/2022 3 SPRING VALLEY MIDDLE/HIGH, 51450 CTY ROAD CC, SPRING VALLEY, WI 54767 10/26/2020 06/30/2022 3 VIKING MIDDLE SCHOOL, 500 SOUTHSIDE DRIVE, WOODVILLE, WI 54028 10/01/2020 06/30/2022
HUDSON HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE 1173
405 STAGELINE ROAD BRIAN BARTLETT Initial Cert: 09/01/1990 HUDSON, WI 54016 [email protected] Cert Eff: 12/01/2019 County: Saint Croix Phone:(715) 531-6755 Cert Exp: 11/30/2021 Surveyor: Rena Andersen Fax: (715) 531-6766
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI 54016 12/01/2019 11/30/2021
MARRIAGE AND FAMILY HEALTH SERVICES, LTD. 2859
2910 ENLOE STREET UNIT 4 VICTOR MICHALEK Initial Cert: 05/01/2009 HUDSON, WI 54016 [email protected] Cert Eff: 05/01/2021 County: Saint Croix Phone:(715) 381-5437 Cert Exp: 04/30/2022 Surveyor: Rena Andersen Fax: (715) 381-5438
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 05/01/2021 04/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 173 of 222 Mental Health Program Directory By County, City, and Provider Name
NEW RICHMOND FAMILY THERAPY ASSOCIATES LLC 3073
150 W FIRST ST SUITE 270 JAMIE MASON Initial Cert: 12/04/2014 NEW RICHMOND, WI 54017 [email protected] Cert Eff: 12/01/2019 County: Saint Croix Phone:(715) 246-4840 Cert Exp: 11/30/2021 Surveyor: Rena Andersen Fax: (715) 254-9459
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 2 FAMILY THERAPY ASSOC, 3610 OAKWOOD MALL DR #104, EAU CLAIRE, WI 54701 12/01/2019 11/30/2021 2 FAMILY THERAPY ASSOC, 700 WOLSKE BAY RD #140, MENOMONIE, WI 54751 12/01/2019 11/30/2021 2 FAMILY THERAPY ASSOC, 138 N MAIN ST. STE. 230, RICE LAKE, WI 54868 06/14/2021 11/30/2021 2 FAMILY THERAPY ASSOC, 250 S WASHINGTON ST, ST CROIX FALLS, WI 54024 12/01/2019 11/30/2021
Non-Certified School Setting(s) Setting Begin/End Dates ALTOONA SCHOOL DISTRICT, 1930 BARTLETT AVE, ALTOONA, WI 54720 12/01/2019 11/30/2021 UNITY ELEMENTARY SCHOOL, 1908 150TH ST HIGHWAY 46N, BALSAM LAKE, WI 54810 12/01/2019 11/30/2021 UNITY SCHOOL DISTRICT, 1908 150TH ST HIGHWAY 46 N, BALSAM LAKE, WI 54810 12/01/2019 11/30/2021 BLOOMER SCHOOL DISTRICT, 1310 17TH AVE, BLOOMER, WI 54724 12/01/2019 11/30/2021 BRUCE ELEM, MIDDLE, & HIGH SCHOOL, 104 W WASHINGTON AVE, BRUCE, WI 54819 12/01/2019 11/30/2021 CAMERON SCHOOL DISTRICT, 600 WISCONSIN AVE, CAMERON, WI 54822 12/01/2019 11/30/2021 COLFAX ELEM, MIDDLE, & HIGH SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730 12/01/2019 11/30/2021 HUDSON SCHOOL DISTRICT, 644 BRAKKE DR, HUDSON, WI 54016 12/01/2019 11/30/2021 LUCK ELEM, MIDDLE, & HIGH SCHOOL, 810 S 7TH ST, LUCK, WI 54853 12/01/2019 11/30/2021 MENOMONIE SCHOOL DISTRICT, 2115 PINE AVE NE, MENOMONIE, WI 54751 12/01/2019 11/30/2021 MONDOVI SCHOOL DISTRICT, 337 N JACKSON ST, MONDOVI, WI 54755 12/01/2019 11/30/2021 OSCEOLA SCHOOLS, 331 MIDDLE SCHOOL DR, OSCEOLA, WI 54020 12/01/2019 11/30/2021 OSSEO-FAIRCHILD, 50851 E ST, OSSEO, WI 54758 12/01/2019 11/30/2021 SOMERSET SCHOOL DISTRICT, 625 SUNRISE DR, PO BOX 100, SOMERSET, WI 54025 12/01/2019 11/30/2021 ST CROIX FALLS ELEMENTARY SCHOOL, 651 E LOUISIANA, ST CROIX FALLS, WI 54024 12/01/2019 11/30/2021 ST CROIX FALLS MIDDLE & HIGH SCHOOL, 740 MAPLE DR, ST CROIX FALLS, WI 54024 12/01/2019 11/30/2021 ELEVA-STRUM PUBLIC SCHOOL, W23597 US HIGHWAY 10, STRUM, WI 54770 12/01/2019 11/30/2021
ST. CROIX COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES - CCS 3110
1752 DORSET LANE REBECCA KERR Initial Cert: 04/01/2016 NEW RICHMOND, WI 54017 [email protected] Cert Eff: 07/01/2020 County: Saint Croix Phone:(715) 246-8485 Cert Exp: 03/31/2022 Surveyor: Rena Andersen Fax: (715) 246-8412
CCS Affiliaton:BEST CCS Begin: 01/01/2019
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2020 03/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 174 of 222 Mental Health Program Directory By County, City, and Provider Name
ST. CROIX COUNTY HEALTH & HUMAN SERVICES - BEHAVIORAL HEALTH 1856
1752 DORSET LANE KATHY HUSTON Initial Cert: 01/01/1990 NEW RICHMOND, WI 54017 [email protected] Cert Eff: 06/01/2021 County: Saint Croix Phone:(715) 246-8204 Cert Exp: 11/30/2022 Surveyor: Rena Andersen Fax: (715) 246-8284
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2021 11/30/2022 NO BRANCH LOCATIONS
ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH 1855
1752 DORSET LANE SHARLENE LOPEZ Initial Cert: 10/01/1975 NEW RICHMOND, WI 54017 [email protected] Cert Eff: 06/01/2021 County: Saint Croix Phone:(715) 246-6991 Cert Exp: 11/30/2022 Surveyor: Rena Andersen Fax: (715) 246-8284 Crisis Intervention Services Regional Designation Begin End Lead HUDSON HOSPITAL CRISIS SERVICES 01/01/2020 NORTHWEST CONNECTIONS SHARED CALL AND CRISIS SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 11/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 06/01/2021 11/30/2022 NO BRANCH LOCATIONS
WESTFIELDS HOSPITAL AND CLINIC 3161
535 HOSPITAL ROAD BRIAN BARTLETT Initial Cert: 12/01/2016 NEW RICHMOND, WI 54017 [email protected] Cert Eff: 12/01/2019 County: Saint Croix Phone:(715) 243-2900 Cert Exp: 11/30/2021 Surveyor: Rena Andersen Fax: (715) 243-2901
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 AMERY HOSPITAL AND CLINIC, 265 GRIFFIN ST E, AMERY, WI 54001 12/01/2019 11/30/2021 1 FREDERIC CLINIC, 201 OAK ST W, FREDERIC, WI 54837 12/01/2019 11/30/2021 1 HUDSON HOSPITAL AND CLINIC, 405 STAGELINE RD, HUDSON, WI 54016 12/01/2019 11/30/2021 1 OSCEOLA MEDICAL CENTER, 2600 65TH AVE, OSCEOLA, WI 54020 12/01/2019 11/30/2021 1 ST CROIX REGIONAL MEDICAL CENTER, 235 E STATE ST, ST CROIX FALLS, WI 54024 12/01/2019 11/30/2021
09/28/2021 Page 175 of 222 Mental Health Program Directory By County, City, and Provider Name
SAINT LOUIS DULUTH ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER 1628
502 EAST SECOND STREET SHERRI GOUGE Initial Cert: 09/01/1987 DULUTH, MN 55805 [email protected] Cert Eff: 12/01/2020 County: Saint Louis Phone:(218) 727-8762 Cert Exp: 05/31/2021 Surveyor: Rena Andersen Fax: (218) 786-5922
Services Adm Code Service Begin/End Dates MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 12/01/2020 05/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2020 05/31/2021 NO BRANCH LOCATIONS
ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER 2083
615 PECAN AVENUE REBECCA HOVERSTEN-MELLEM Initial Cert: 10/01/1998 DULUTH, MN 55811 [email protected] Cert Eff: 12/01/2020 County: Saint Louis Phone:(218) 786-2100 Cert Exp: 11/30/2022 Surveyor: Rena Andersen Fax: (218) 786-2105
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH INTENSIVE HOSPITAL BASED DHS 40.03(20) 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER 1423
1401 E 1ST STREET KATIE ONOFREYCHUK Initial Cert: 12/01/1982 DULUTH, MN 55805 [email protected] Cert Eff: 10/01/2020 County: Saint Louis Phone:(218) 728-4491 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (218) 302-8698
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 HUMAN DEVELOPMENT CENTER, 1406 EAST 2ND STREET, DULUTH, MN 55805 10/01/2020 06/30/2022 1 HUMAN DEVELOPMENT CENTER, 810 E 4TH STREET, DULUTH, MN 55805 10/12/2020 06/30/2022 1 HUMAN DEVELOPMENT CENTER, 1500 N 34TH ST STE #100, SUPERIOR, WI 54880 10/01/2020 06/30/2022 1 HUMAN DEVELOPMENT CENTER, 325 11TH AVENUE, TWO HARBORS, MN 55616 10/01/2020 06/30/2022
SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH 3023
530 E 2ND STREET RICHARD GERTSEMA Initial Cert: 02/25/2014 DULUTH, MN 55805 [email protected] Cert Eff: 09/10/2020 County: Saint Louis Phone:(218) 786-5990 Cert Exp: 01/31/2022 Surveyor: Rena Andersen Fax: (218) 722-0373
Services Adm Code Service Begin/End Dates MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/10/2020 01/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 176 of 222 Mental Health Program Directory By County, City, and Provider Name
SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH CLINIC 2999
502 EAST 2ND STREET RICHARD GERTSEMA Initial Cert: 03/06/2013 DULUTH, MN 55805 [email protected] Cert Eff: 03/01/2020 County: Saint Louis Phone:(218) 786-1186 Cert Exp: 02/28/2022 Surveyor: Rena Andersen Fax: (218) 722-0373
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 1 THE DULUTH CLINIC DBA ESSENTIA HLTH ASHLAND CLINIC, 1615 MAPLE LN STE 1, ASHLAND, WI 03/01/2020 02/28/2022 54806 1 ESSENTIA HEALTH - LAKEWALK CLINIC, 1502 LONDON RD, DULUTH, MN 55812 03/01/2020 02/28/2022 1 ESSENTIA HLTH DULUTH AMBERWING, 615 PECAN AVE, DULUTH, MN 55811 03/01/2020 02/28/2022 1 ESSENTIA HEALTH - PROCTOR CLINIC, 211 S BOUNDARY AVE, PROCTOR, MN 55810 03/01/2020 02/28/2022
2 ESSENTIA HEALTH - LAKESIDE CLINIC, 4621 E SUPERIOR ST, DULUTH, MN 55804 03/01/2020 02/28/2022 2 ESSENTIA HEALTH - WEST DULUTH CLINIC, 4212 GRAND AVE, DULUTH, MN 55807 03/01/2020 02/28/2022 2 ESSENTIA HLTH HERMANTOWN, 4855 W ARROWHEAD RD, HERMANTOWN, MN 55811 03/01/2020 02/28/2022 2 ESSENTIA HLTH ST MARY'S HOSP & CLINIC SUPERIOR, 3500 TOWER AVENUE, SUPERIOR, WI 54880 03/01/2020 02/28/2022
ST. LUKE'S HOSPITAL 1865
915 E. FIRST STREET EVAN JANSON Initial Cert: 02/01/1995 DULUTH, MN 55805 [email protected] Cert Eff: 02/01/2021 County: Saint Louis Phone:(218) 249-5503 Cert Exp: 01/31/2023 Surveyor: Rena Andersen Fax: (218) 249-2457
Services Adm Code Service Begin/End Dates MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 177 of 222 Mental Health Program Directory By County, City, and Provider Name
SAUK BARABOO INNERVISIONS COUNSELING AND CONSULTING CENTER, SC 1436
840 STATE ROAD 136, SUITE 1 COLLEEN JAMES Initial Cert: 11/19/2007 BARABOO, WI 53913 [email protected] Cert Eff: 05/01/2021 County: Sauk Phone:(608) 477-9858 Cert Exp: 10/31/2022 Surveyor: Tina Dary Fax: (877) 560-0578
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 INNERVISIONS COUNSELING & CONSULTING CENTER, 231 EAST STATE ST, MAUSTON, WI 53948 05/01/2021 10/31/2022 1 DELTON FAMILY MEDICAL CENTER, 28 COMMERCE ST, WISCONSIN DELLS, WI 53965 05/01/2021 10/31/2022
2 MILE BLUFF CLINIC, 1040 DIVISION ST., MAUSTON, WI 53948 05/01/2021 10/31/2022 2 INNERVISIONS COUNSELING & CONSULTING CENTER, 129 EAST BRIDGE STREET, NEW LISBON, WI 05/01/2021 10/31/2022 53950 3 JACK YOUNG MIDDLE SCHOOL, 1531 DRAPER ST, BARABOO, WI 53913 05/01/2021 10/31/2022 3 OLSON MIDDLE SCHOOL, 508 GRAYSIDE AVENUE, MAUSTON, WI 53948 05/01/2021 10/31/2022 3 NECEDAH MIDDLE/HIGH SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 54646 05/01/2021 10/31/2022 3 WONEWOC-CENTER SCHOOL, 101 SCHOOL RD, WONEWOC, WI 53968 05/01/2021 10/31/2022
SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2713
505 BROADWAY ST JILL ELLINWOOD Initial Cert: 03/01/2007 BARABOO, WI 53913 [email protected] Cert Eff: 03/01/2021 County: Sauk Phone:(608) 355-4200 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 355-4299
CCS Affiliaton:WISCONSIN RIVER CCS COLLABORATION Begin: 07/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 1 SAUK COUNTY DEPT HUMAN SERVICES REEDSBURG, 425 - 6TH STREET, REEDSBURG, WI 53959 03/01/2021 02/28/2023
SAUK COUNTY DEPARTRMENT OF HUMAN SERVICES 1824
505 BROADWAY STREET JESSICA MIJAL Initial Cert: 01/01/1988 BARABOO, WI 53913 [email protected] Cert Eff: 01/01/2020 County: Sauk Phone:(608) 355-4200 Cert Exp: 12/31/2021 Surveyor: Tina Dary Fax: (608) 355-4299 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 HOME YOUTH DIVERSION PROGRAM 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2020 12/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 SAUK COUNTY DHS - REEDSBURG OFFICE, 425 SIXTH STREET, REEDSBURG, WI 53959 01/01/2020 12/31/2021
09/28/2021 Page 178 of 222 Mental Health Program Directory By County, City, and Provider Name
SEASONS COUNSELING LLC 3321
1212 8TH STREET, STE 3 TIFFANY OVERLIEN Initial Cert: 03/16/2021 BARABOO, WI 53913 [email protected] Cert Eff: 03/16/2021 County: Sauk Phone:(608) 434-5145 Cert Exp: 02/28/2022 Surveyor: Tina Dary Fax: (608) 448-2865
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/16/2021 02/28/2022 NO BRANCH LOCATIONS REEDSBURG GOODMAN'S BEHAVIORAL HEALTH CLINIC LLC 2774
2213 E MAIN STREET BARBARA GOODMAN Initial Cert: 03/06/2008 REEDSBURG, WI 53959 [email protected] Cert Eff: 03/01/2021 County: Sauk Phone:(608) 768-4545 Cert Exp: 02/28/2023 Surveyor: Tina Dary Fax: (608) 768-4646
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 1823
425 SIXTH STREET NICOLAS CIBULKA Initial Cert: 07/01/1990 REEDSBURG, WI 53959 [email protected] Cert Eff: 10/01/2020 County: Sauk Phone:(608) 524-7920 Cert Exp: 06/30/2022 Surveyor: Tina Dary Fax: (608) 524-7980
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 179 of 222 Mental Health Program Directory By County, City, and Provider Name
SAWYER HAYWARD LAC COURTE ORIELLES BEHAVIORAL HEALTH 1486
13447 W COUNTY HWY B STE 1 MARIE BASTY Initial Cert: 03/01/1987 HAYWARD, WI 54843 [email protected] Cert Eff: 07/01/2021 County: Sawyer Phone:(715) 699-1922 Cert Exp: 06/30/2023 Surveyor: Rena Andersen Fax: (715) 634-6107
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 3 LCO OJIBWE SCHOOL, 8575 N ROUND LAKE SCHOOL RD, HAYWARD, WI 54843 07/01/2021 06/30/2023
LCO CCS 3160
13447 W COUNTY RD B, STE 2 MARIE BASTY Initial Cert: 05/01/2017 HAYWARD, WI 54843 [email protected] Cert Eff: 05/01/2021 County: Sawyer Phone:(715) 699-1916 Cert Exp: 04/30/2023 Surveyor: Rena Andersen Fax: (715) 558-7821
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM 2330
10270 OLKER ROAD CAROL LUND Initial Cert: 02/01/2001 HAYWARD, WI 54843 [email protected] Cert Eff: 09/01/2020 County: Sawyer Phone:(715) 634-2522 Cert Exp: 08/31/2022 Surveyor: Rena Andersen Fax: (715) 634-2533
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2020 08/31/2022 NO BRANCH LOCATIONS
NORTHLAND COUNSELING SERVICES LTD 2213
10752 BEAL STREET CAROL LUND Initial Cert: 04/03/2000 HAYWARD, WI 54843 [email protected] Cert Eff: 07/01/2020 County: Sawyer Phone:(715) 634-0222 Cert Exp: 03/31/2022 Surveyor: Rena Andersen Fax: (715) 634-1722
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2020 03/31/2022 NO BRANCH LOCATIONS
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - HAYWARD 3049
16092 US HIGHWAY 63 CURTIS EMERSON Initial Cert: 09/16/2014 HAYWARD, WI 54843 [email protected] Cert Eff: 09/01/2021 County: Sawyer Phone:(715) 699-1241 Cert Exp: 08/31/2023 Surveyor: Rena Andersen Fax: (175) 699-1243
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 180 of 222 Mental Health Program Directory By County, City, and Provider Name
SAWYER COUNTY HEALTH & HUMAN SERVICES/INFORMATION & REFERRAL CENTER 1825
10610 MAIN ST SUITE 224 ALICIA CARLSON Initial Cert: 04/01/1979 HAYWARD, WI 54843 [email protected] Cert Eff: 10/01/2020 County: Sawyer Phone:(715) 634-4806 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 634-3580
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
SAWYER COUNTY HUMAN SERVICES/NORTHLAND COUNSELING SERVICES 2998
10270 OLKER ROAD CAROL LUND Initial Cert: 10/01/2013 HAYWARD, WI 54843 [email protected] Cert Eff: 04/01/2021 County: Sawyer Phone:(715) 638-3334 Cert Exp: 09/30/2022 Surveyor: Rena Andersen Fax: (715) 634-5019 Crisis Intervention Services Regional Designation Begin End Lead COLLABORATIVE CRISIS INTERVENTION SERVICES TO YOUTH 01/01/2020 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 09/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 181 of 222 Mental Health Program Directory By County, City, and Provider Name
SHAWANO BOWLER STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER 1882
W12802 COUNTY HWY A JEFF LANGLOIS Initial Cert: 06/19/2014 BOWLER, WI 54416 [email protected] Cert Eff: 08/01/2020 County: Shawano Phone:(715) 793-3003 Cert Exp: 07/31/2022 Surveyor: Renee DeWitt Fax: (715) 793-1312
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022 NO BRANCH LOCATIONS GRESHAM MAEHNOWESEKIYAH WELLNESS CENTER 1554
N2150 KESAEHKAHTEK ADDIE CALDWELL Initial Cert: 11/21/1989 GRESHAM, WI 54128 [email protected] Cert Eff: 12/01/2019 County: Shawano Phone:(715) 799-3835 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (715) 799-5056
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 12/01/2019 11/30/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 CSAS-PREVENTION DHS 75.04 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 NO BRANCH LOCATIONS SHAWANO SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER 1831
W7327 ANDERSON AVE JENNIFER FROST Initial Cert: 03/01/1977 SHAWANO, WI 54166 [email protected] Cert Eff: 01/01/2021 County: Shawano Phone:(715) 526-4700 Cert Exp: 12/31/2022 Surveyor: Renee DeWitt Fax: (715) 526-5542 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS 2863
W7327 ANDERSON AVE GREG THOUSAND Initial Cert: 05/06/2014 SHAWANO, WI 54166 [email protected] Cert Eff: 07/01/2021 County: Shawano Phone:(715) 526-4700 Cert Exp: 06/30/2023 Surveyor: Renee DeWitt Fax: (715) 526-5542
CCS Affiliaton:LAKESHORE RECOVERY CONSORTIUM Begin: 12/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2021 06/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 182 of 222 Mental Health Program Directory By County, City, and Provider Name
SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CSP 2242
W7327 ANDERSON AVE GREG THOUSAND Initial Cert: 01/01/2000 SHAWANO, WI 54166 [email protected] Cert Eff: 01/01/2021 County: Shawano Phone:(715) 524-6834 Cert Exp: 12/31/2022 Surveyor: Renee DeWitt Fax: (715) 526-5542
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 183 of 222 Mental Health Program Directory By County, City, and Provider Name
SHEBOYGAN SHEBOYGAN AURORA SHEBOYGAN CLINIC 1925
2414 KOHLER MEMORIAL DRIVE TRACY LEE-JOHNSON Initial Cert: 07/01/1986 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 10/01/2020 County: Sheboygan Phone:(920) 459-1494 Cert Exp: 06/30/2022 Surveyor: Renee DeWitt Fax: (920) 459-1483
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 AURORA HEALTH CENTER KIEL, 1001 SERVICE ROAD, KIEL, WI 53042 10/01/2020 06/30/2022
2 AURORA SHEBOYGAN CLINIC, 2600 KILEY WAY, PLYMOUTH, WI 53073 10/01/2020 06/30/2022 2 AURORA HEALTH CENTER, 1813 ASHLAND AVE, SHEBOYGAN, WI 53081 10/01/2020 06/30/2022
AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER 1835
2629 N 7TH STREET LORI KNITT Initial Cert: 05/01/1987 SHEBOYGAN, WI 53083 [email protected] Cert Eff: 08/01/2020 County: Sheboygan Phone:(920) 451-5510 Cert Exp: 04/30/2022 Surveyor: Renee DeWitt Fax: (920) 451-5123
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 08/01/2020 04/30/2022 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 08/01/2020 04/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/17/2020 04/30/2022 MENTAL HEALTH-INPATIENT DHS 61.71 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER-AURORA BEHAVIORAL HEALTH CENTER 3171
1221 N 26TH STREET JESSICA MCCARDELL Initial Cert: 12/26/2016 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 08/01/2020 County: Sheboygan Phone:(920) 453-3564 Cert Exp: 04/30/2022 Surveyor: Renee DeWitt Fax: (920) 453-3901
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2020 04/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2020 04/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2020 04/30/2022 NO BRANCH LOCATIONS
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. 1133
503 WISCONSIN AVENUE RICARDO CISNEROS Initial Cert: 04/01/1983 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 05/01/2021 County: Sheboygan Phone:(920) 458-5726 Cert Exp: 04/30/2023 Surveyor: Renee DeWitt Fax: (920) 458-5826
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 CATHOLIC CHARITIES ARCHDIOCESE OF MILW INC, 191 S MAIN STREET, FOND DU LAC, WI 54935 05/01/2021 04/30/2023
09/28/2021 Page 184 of 222 Mental Health Program Directory By County, City, and Provider Name
NETT-WORK FAMILY COUNSELING, LLC 1656
2801 CALUMET DRIVE CHRISTINE M. NETT Initial Cert: 02/27/1998 SHEBOYGAN, WI 53083 [email protected] Cert Eff: 03/01/2020 County: Sheboygan Phone:(920) 451-6908 Cert Exp: 02/28/2022 Surveyor: Renee DeWitt Fax: (920) 458-6439
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 1 NETT-WORK FAMILY COUNSELING LLC, 1011 - 10TH STREET #1, MANITOWOC, WI 54220 03/01/2020 02/28/2022 1 NETT-WORK FAMILY COUNSELING LLC, 1403 MILWAUKEE DR, NEW HOLSTEIN, WI 53061 03/01/2020 02/28/2022 1 NETT-WORK FAMILY COUNSELING LLC, 621 E MILL ST, PLYMOUTH, WI 53073 03/01/2020 02/28/2022
2 NETT-WORK FAMILY COUNSELING, LLC, 3321 SOUTH 12TH ST, SHEBOYGAN, WI 53081 03/01/2020 02/28/2022
NORTHSHORE CLINIC LLC 1699
805 NORTH 6TH STREET LORI DIELENTHEIS Initial Cert: 08/01/1991 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 03/01/2020 County: Sheboygan Phone:(920) 457-8866 Cert Exp: 02/28/2022 Surveyor: Renee DeWitt Fax: (920) 457-8867
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Non-Certified School Setting(s) Setting Begin/End Dates JEFFERSON ELEMENTARY SCHOOL, 1538 N 15TH ST, SHEBOYGAN, WI 53081 03/01/2020 02/28/2022 LONGFELLOW ELEMENTARY SCHOOL, 819 KENTUCKY AVE, SHEBOYGAN, WI 53081 03/01/2020 02/28/2022
SHEBOYGAN CO HEALTH AND HUMAN SERVICES CSP 3194
1011 N 8TH ST TROY KREPSKY Initial Cert: 01/29/2018 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 02/01/2021 County: Sheboygan Phone:(920) 459-4382 Cert Exp: 01/31/2023 Surveyor: Renee DeWitt Fax: (920) 459-4353
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
SHEBOYGAN COUNTY DEPT OF HEALTH AND HUMAN SERVICES 1834
1011 N 8TH STREET TANYA BRICCO Initial Cert: 07/01/1986 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 10/01/2020 County: Sheboygan Phone:(920) 459-3169 Cert Exp: 09/30/2022 Surveyor: Renee DeWitt Fax: (920) 459-4353 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2020 09/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 09/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 09/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 185 of 222 Mental Health Program Directory By County, City, and Provider Name
SHEBOYGAN COUNTY HEALTH AND HUMAN SERVICES CCS 3286
1011 N 8TH STREET TROY KREPSKY Initial Cert: 01/01/2020 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 01/01/2020 County: Sheboygan Phone:(920) 459-3207 Cert Exp: 12/31/2021 Surveyor: Renee DeWitt Fax: (920) 459-6459
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
ST. NICHOLAS HOSPITAL DBA PREVEA HEALTH 3070
3425 SUPERIOR AVE LISA TUTSKEY Initial Cert: 10/27/2014 SHEBOYGAN, WI 53081 [email protected] Cert Eff: 12/01/2019 County: Sheboygan Phone:(920) 272-1200 Cert Exp: 11/30/2021 Surveyor: Renee DeWitt Fax: (920) 272-1201
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 STOELTING HEALTH & WELLNESS, 502 HWY 67, KIEL, WI 53042 03/01/2021 11/30/2021 1 PREVEA HEALTH KOHLER, 444 HIGHLAND DRIVE, KOHLER, WI 53044 01/04/2021 11/30/2021 1 PREVEA HEALTH KOHLER, 950 WOODLAKE RD, KOHLER, WI 53044 12/01/2019 11/30/2021 1 VOLLRATH HEALTH AND WELLNESS CLINIC, 1236 N 18TH ST, SHEBOYGAN, WI 53081 12/01/2019 11/30/2021
2 PREVEA PLYMOUTH HEALTH CENTER, 825 WALTON DR, PLYMOUTH, WI 53073 12/01/2019 11/30/2021
09/28/2021 Page 186 of 222 Mental Health Program Directory By County, City, and Provider Name
TAYLOR MEDFORD ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. 1577
143 SOUTH GIBSON ST NICKI WILLIAMS Initial Cert: 01/01/1978 MEDFORD, WI 54451 [email protected] Cert Eff: 09/01/2021 County: Taylor Phone:(715) 421-7470 Cert Exp: 08/31/2023 Surveyor: Rena Andersen Fax: (715) 442-7731
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ASPIRUS PHILLIPS CLINIC, 625 PETERSON AVE, PHILLIPS, WI 54555 09/01/2021 08/31/2023 1 ASPIRUS PRENTICE CLINIC, 1511 RAILROAD AVE, PRENTICE, WI 54556 09/01/2021 08/31/2023
COUNSELING CONNECTION OF MEDFORD, LLC 2753
429 W BROADWAY AVE KELLY SCHULTZ Initial Cert: 09/01/2007 MEDFORD, WI 54451 [email protected] Cert Eff: 09/01/2021 County: Taylor Phone:(715) 748-4312 Cert Exp: 08/31/2023 Surveyor: Rena Andersen Fax: (715) 748-4407
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 PHOENIX HOUSE, 600 W HICKORY ST, GILMAN, WI 54433 09/01/2021 08/31/2023
3 HOLY ROSARY SCHOOL, 215 S WASHINGTON AVE, MEDFORD, WI 54451 09/01/2021 08/31/2023 3 MEDFORD ADULT DIPLOMA ACADEMY & ALT ED PROGRAM, 624 E COLLEGE ST, MEDFORD, WI 09/01/2021 08/31/2023 54451 3 MEDFORD ELEMENTARY SCHOOL-COUNSELING CONNECTION, 1065 W BROADWAY AVE, 09/01/2021 08/31/2023 MEDFORD, WI 54451 3 MEDFORD HIGH SCHOOL-COUNSELING CONNECTION, 1015 W BROADWAY AVE, MEDFORD, WI 09/01/2021 08/31/2023 54451 3 MEDFORD MIDDLE SCHOOL-COUNSELING CONNECTION, 509 CLARK ST, MEDFORD, WI 54451 09/01/2021 08/31/2023 3 RIB LAKE ELEMENTARY SCHOOL, 1236 KENNEDY ST, RIB LAKE, WI 54470 09/01/2021 08/31/2023 3 RIB LAKE HIGH SCHOOL, 1200 NORTH STREET, RIB LAKE, WI 54470 09/20/2021 08/31/2023 3 STETSONVILLE ELEMENTARY SCHOOL, W5338 COUNTY RD A, STETSONVILLE, WI 54480 09/01/2021 08/31/2023
NORTH CENTRAL REGION CCS PROGRAM 3193
540 E COLLEGE STREET CHERYL KETELHUT Initial Cert: 01/01/2018 MEDFORD, WI 54451 [email protected] Cert Eff: 01/01/2020 County: Taylor Phone:(715) 748-3332 Cert Exp: 12/31/2021 Surveyor: Rena Andersen Fax: (715) 748-3342
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 SAWYER COUNTY HEALTH AND HUMAN SVS, 10610 MAIN STREET, STE 224, HAYWARD, WI 54843 01/01/2020 12/31/2021 1 IRON COUNTY HUMAN SERVICES & ASSOC, 300 TACONITE STREET, STE 201, HURLEY, WI 54534 01/01/2020 12/31/2021 1 PRICE COUNTY HEALTH AND HUMAN SVS, 104 SOUTH EYDER, PHILLIPS, WI 54555 01/01/2020 12/31/2021
09/28/2021 Page 187 of 222 Mental Health Program Directory By County, City, and Provider Name
TAYLOR COUNTY HUMAN SERVICES DEPARTMENT 1898
540 E. COLLEGE STREET JEN MEYER Initial Cert: 06/01/1982 MEDFORD, WI 54451 [email protected] Cert Eff: 10/01/2020 County: Taylor Phone:(715) 748-3332 Cert Exp: 06/30/2022 Surveyor: Rena Andersen Fax: (715) 748-3342 Crisis Intervention Services Regional Designation Begin End Lead COLLABORATIVE CRISIS INTERVENTION SERVICES TO YOUTH 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 188 of 222 Mental Health Program Directory By County, City, and Provider Name
TREMPEALEAU WHITEHALL TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES CSP 3170
36245 MAIN STREET DEBRA SUCHLA Initial Cert: 03/01/2017 WHITEHALL, WI 54773 [email protected] Cert Eff: 03/01/2020 County: Trempealeau Phone:(715) 538-2311 Cert Exp: 02/28/2022 Surveyor: Roderick Senn Fax: (715) 538-4274
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
TREMPEALEAU COUNTY HUMAN SERVICES - CCS 3094
36245 MAIN ST ERICA ANDERSON Initial Cert: 09/01/2015 WHITEHALL, WI 54773 [email protected] Cert Eff: 09/01/2021 County: Trempealeau Phone:(715) 538-2311 Cert Exp: 08/31/2023 Surveyor: Roderick Senn Fax: (715) 538-4174
CCS Affiliaton:CCS OF CLARK AND TREMPEALEAU COUNTIES Begin: 09/01/2015
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC 2543
N36647 COUNTY ROAD QQQ JERRY DEETZ Initial Cert: 09/03/2004 WHITEHALL, WI 54773 [email protected] Cert Eff: 09/01/2021 County: Trempealeau Phone:(715) 538-9495 Cert Exp: 08/31/2023 Surveyor: Roderick Senn Fax: (715) 538-9496
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 189 of 222 Mental Health Program Directory By County, City, and Provider Name
VERNON HILLSBORO GUNDERSEN ST JOSEPH'S HOSPITAL & CLINICS-HILLSBORO CLINIC 3145
400 WATER AVE CARRIE KRUEGER Initial Cert: 08/26/2016 HILLSBORO, WI 54634 [email protected] Cert Eff: 09/01/2020 County: Vernon Phone:(608) 489-8106 Cert Exp: 08/31/2022 Surveyor: Roderick Senn Fax: (608) 489-8181
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 08/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 GUNDERSEN ST JOSEPH'S HOSP & CLINICS-ELROY, 1705 OMAHA, ELROY, WI 53929 09/01/2020 08/31/2022 1 GUNDERSEN ST JOSEPH'S HOSP & CLINICS-WONEWOC, 301 RAILROAD ST, WONEWOC, WI 53968 09/01/2020 08/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ROYALL SCHOOL, 1501 ACADAMY STREET, ELROY, WI 53929 09/01/2020 08/31/2022 HILLSBORO SCHOOL, 777 SCHOOL ROAD, HILLSBORO, WI 54634 09/01/2020 08/31/2022 WONEWOC SCHOOL, 101 SCHOOL ROAD, WONEWOC, WI 53968 09/01/2020 08/31/2022
VIROQUA FAMILY AND CHILDREN'S CENTER, INC. COMMUNITY SUPPORT PROGRAM 1317
1321 N MAIN ST SUZIE HOWE Initial Cert: 01/01/1996 VIROQUA, WI 54665 [email protected] Cert Eff: 05/01/2021 County: Vernon Phone:(608) 637-7052 Cert Exp: 04/30/2023 Surveyor: Roderick Senn Fax: (608) 637-8500
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
STONEHOUSE COUNSELING 3304
414 S EAST AVENUE SUSAN TOWNSLEY Initial Cert: 11/02/2020 VIROQUA, WI 54665 [email protected] Cert Eff: 11/02/2020 County: Vernon Phone:(608) 638-3332 Cert Exp: 10/31/2022 Surveyor: Roderick Senn Fax: (608) 673-7328
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/02/2020 10/31/2022 NO BRANCH LOCATIONS
STRIVE COMPREHENSIVE COMMUNITY SERVICES 3092
318 FAIRLANE DRIVE SUITE 100 JILL BENDER Initial Cert: 08/01/2015 VIROQUA, WI 54665 [email protected] Cert Eff: 07/01/2021 County: Vernon Phone:(608) 637-5210 Cert Exp: 07/31/2022 Surveyor: Roderick Senn Fax: (608) 637-5505
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL MULTI-COUNTY DHS 36 07/01/2021 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CRAWFORD CO DEPT. OF HUMAN SERVICES, 225 N. BEAUMONT RD SUITE 326, PRAIRIE DU CHIEN, 07/01/2021 07/31/2022 WI 53821
09/28/2021 Page 190 of 222 Mental Health Program Directory By County, City, and Provider Name
WESTBY HIDDEN SPRINGS CLINIC 2565
S 1597 HANSON ROAD DEAN JENSEN Initial Cert: 12/09/2004 WESTBY, WI 54667 [email protected] Cert Eff: 10/01/2020 County: Vernon Phone:(608) 574-0582 Cert Exp: 06/30/2022 Surveyor: Roderick Senn Fax: (608) 634-6918
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 191 of 222 Mental Health Program Directory By County, City, and Provider Name
VILAS LAC DU FLAMBEAU FAMILY RESOURCE CENTER 1325
533 PEACE PIPE ROAD LAURIE BUESING Initial Cert: 09/01/1988 LAC DU FLAMBEAU, WI 54538 [email protected] Cert Eff: 09/01/2021 County: Vilas Phone:(715) 588-1511 Cert Exp: 08/31/2023 Surveyor: Rena Andersen Fax: (715) 588-3903
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 DOMESTIC ABUSE PROGRAM, 157 CEDAR AVE, LAC DU FLAMBEAU, WI 54538 09/01/2021 08/31/2023
3 ARBOR VITAE-WOODRUFF ELEMENTARY, 11065 OLD HWY 51 N, ARBOR VITAE, WI 54568 09/01/2021 08/31/2023 3 LAC DU FLAMBEAU PUBLIC SCHOOL, 2899 HIGHWAY 47, LAC DU FLAMBEAU, WI 54538 09/01/2021 08/31/2023 3 LAKELAND UNION HIGH SCHOOL, 9573 STATE HIGHWAY 70, MINOCQUA, WI 54548 09/01/2021 08/31/2023
GOOKOMIS ENDAAD 3100
3378 N SCHILLEMAN RD MELINDA YOUNG Initial Cert: 01/19/2016 LAC DU FLAMBEAU, WI 54538 [email protected] Cert Eff: 03/01/2021 County: Vilas Phone:(715) 588-4422 Cert Exp: 02/28/2023 Surveyor: Rena Andersen Fax: (715) 588-1889
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS 3071
533 PEACE PIPE ROAD LAURIE BUESING Initial Cert: 02/01/2015 LAC DU FLAMBEAU, WI 54538 [email protected] Cert Eff: 02/01/2020 County: Vilas Phone:(715) 588-1511 Cert Exp: 01/31/2022 Surveyor: Rena Andersen Fax: (715) 588-3903
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 192 of 222 Mental Health Program Directory By County, City, and Provider Name
WALWORTH ELKHORN CREDENCE THERAPY ASSOCIATES 1262
1-1/2 W. GENEVA STREET KIM STEEN Initial Cert: 12/19/1995 ELKHORN, WI 53121 [email protected] Cert Eff: 12/01/2020 County: Walworth Phone:(262) 723-3424 Cert Exp: 11/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 723-8308
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2020 11/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 ELKHORN AREA HIGH SCHOOL, 482 EAST GENEVA STREET, ELKHORN, WI 53121 12/01/2020 11/30/2022 3 ELKHORN AREA MIDDLE SCHOOL, 627 EAST COURT ST., ELKHORN, WI 53121 12/01/2020 11/30/2022 3 JACKSON ELEMENTARY SCHOOL, 13 NORTH JACKSON STREET, ELKHORN, WI 53121 12/01/2020 11/30/2022 3 TIBBETS ELEMENTARY SCHOOL, W5218 COUNTY ROAD A, ELKHORN, WI 53121 12/01/2020 11/30/2022 3 WALWORTH CO ALT HIGH SCHOOL, 400 CTY RD H, ELKHORN, WI 53121 12/01/2020 11/30/2022 3 WEST SIDE ELEMENTARY SCHOOL, 222 SUNSET DRIVE, ELKHORN, WI 53121 12/01/2020 11/30/2022 3 BADGER HIGH SCHOOL, 220 E. SOUTH STREET, LAKE GENEVA, WI 53147 12/01/2020 11/30/2022 3 CENTRAL-DENISON ELEMENTARY, 900 WISCONSIN ST, LAKE GENEVA, WI 53147 12/01/2020 11/30/2022 3 EASTVIEW ELEMENTARY, 535 SAGE ST, LAKE GENEVA, WI 53147 12/01/2020 11/30/2022 3 LAKE GENEVA MIDDLE SCHOOL, 600 BLOOMFIELD ROAD, LAKE GENEVA, WI 53147 12/01/2020 11/30/2022 3 BIG FOOT HIGH SCHOOL, 401 DEVILS LANE PO BOX 89, WALWORTH, WI 53184 12/01/2020 11/30/2022
WALWORTH COUNTY DEPT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM 2694
1910 COUNTY ROAD NN CARLO NEVICOSI Initial Cert: 11/08/2006 ELKHORN, WI 53121 [email protected] Cert Eff: 12/09/2019 County: Walworth Phone:(262) 741-3223 Cert Exp: 11/30/2021 Surveyor: Anastasia E. Vega Fax: (262) 741-3217
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/09/2019 11/30/2021 NO BRANCH LOCATIONS
WALWORTH COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES 2889
1910 COUNTY ROAD NN CARLO NEVICOSI Initial Cert: 01/20/2010 ELKHORN, WI 53121 [email protected] Cert Eff: 02/01/2021 County: Walworth Phone:(262) 741-3223 Cert Exp: 01/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 741-3217
CCS Affiliaton:JRW TRI COUNTY REGIONAL CCS Begin: 08/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 193 of 222 Mental Health Program Directory By County, City, and Provider Name
WALWORTH COUNTY HEALTH AND HUMAN SERVICES 1967
1910 COUNTY ROAD NN CARLO NEVICOSI Initial Cert: 10/01/1975 ELKHORN, WI 53121 [email protected] Cert Eff: 07/01/2021 County: Walworth Phone:(262) 741-3223 Cert Exp: 08/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 741-3217 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 DANE COUNTY CARE CENTER CRISIS SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 08/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2021 08/31/2022 NO BRANCH LOCATIONS LAKE GENEVA AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES - LAKE GENEVA 2517
146 E GENEVA SQUARE DON NEUMANN Initial Cert: 02/01/2004 LAKE GENEVA, WI 53147 [email protected] Cert Eff: 02/01/2021 County: Walworth Phone:(414) 442-2434 Cert Exp: 01/31/2023 Surveyor: Anastasia E. Vega Fax: (414) 422-2188
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 AURORA HEALTH CENTER - WALWORTH, 525 KENOSHA ST, WALWORTH, WI 53184 02/01/2021 01/31/2023
2 AURORA HEALTH CENTER - DELAVAN, 1550 HOBBS DR, DELAVAN, WI 53115 02/01/2021 01/31/2023 2 AURORA HEALTH CENTER - ELKHORN, 201 E MORRISEY DR, ELKHORN, WI 53121 02/01/2021 01/31/2023
LAKE GENEVA WELLNESS CLINIC 1492
750 VETERANS PKWY, STE 100 CHERYL ARMSTRONG Initial Cert: 02/01/1984 LAKE GENEVA, WI 53147 [email protected] Cert Eff: 07/01/2021 County: Walworth Phone:(262) 248-7942 Cert Exp: 03/31/2023 Surveyor: Anastasia E. Vega Fax: (262) 248-1202
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 03/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates WHEATLAND CENTER SCHOOL, 6606 368TH AVE, BURLINGTON, WI 53105 07/01/2021 03/31/2023 RIVERVIEW SCHOOL, 300 E. PROSSER ST., SILVER LAKE, WI 53170 07/01/2021 03/31/2023
09/28/2021 Page 194 of 222 Mental Health Program Directory By County, City, and Provider Name
WASHBURN SHELL LAKE SOAR SERVICES, INC. 2506
246 INDUSTRIAL BLVD ROXANNE MELTON Initial Cert: 03/11/2004 SHELL LAKE, WI 54871 [email protected] Cert Eff: 04/01/2020 County: Washburn Phone:(715) 468-2841 Cert Exp: 03/31/2022 Surveyor: Rena Andersen Fax: (715) 468-2374
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2020 03/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 SOAR SERVICES, INC, 15910 COMPANY LAKE ROAD, HAYWARD, WI 54843 04/01/2020 03/31/2022 1 SOAR SERVICES SUPERIOR, 625 HUGHITT AVE, SUPERIOR, WI 54880 09/01/2020 03/31/2022
2 SOAR SERVICES, INC, 517 BEASER AVENUE, ASHLAND, WI 54806 04/01/2020 03/31/2022 2 SOAR SERVICES, INC, 370 3RD AVE SO, PARK FALLS, WI 54552 04/01/2020 03/31/2022 2 SOAR SERVICES, INC, 24670 STATE ROAD 35/70, STE 700, SIREN, WI 54872 04/01/2020 03/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates ASHLAND SCHOOLS, 2000 BEASER AVE, ASHLAND, WI 54806 04/01/2020 03/31/2022 BARRON SCHOOL, 100 WEST RIVER AVE, BARRON, WI 54812 04/01/2020 03/31/2022 BIRCHWOOD SCHOOL, 300 S. WILSON ST, BIRCHWOOD, WI 54817 04/01/2020 03/31/2022 CHEQUAMAGON SCHOOL, 420 9TH ST NORTH, EISENSTEIN, WI 54552 04/01/2020 03/31/2022 SHELL LAKE SCHOOLS, 271 HWY 63, SHELL LAKE, WI 54871 04/01/2020 03/31/2022 SPOONER SCHOOLS, 801 CO. HWY A, SPOONER, WI 54801 04/01/2020 03/31/2022
WASHBURN COUNTY COMMUNITY SUPPORT PROGRAM 2926
304 2ND ST. KIM CAMPION Initial Cert: 11/01/2010 SHELL LAKE, WI 54871 [email protected] Cert Eff: 08/31/2020 County: Washburn Phone:(715) 468-0406 Cert Exp: 10/31/2021 Surveyor: Rena Andersen Fax: (715) 468-1588
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/31/2020 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 195 of 222 Mental Health Program Directory By County, City, and Provider Name
SPOONER ACCESS, INC. 2631
4851 HWY 63 SOUTH TERRI BOLLINGER Initial Cert: 01/01/2006 SPOONER, WI 54801 [email protected] Cert Eff: 01/01/2020 County: Washburn Phone:(715) 563-7776 Cert Exp: 12/31/2021 Surveyor: Rena Andersen Fax: (715) 635-4861
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 406 TECHNOLOGY DR. E SIUITE C, 01/01/2020 12/31/2021 MENOMONIE, WI 54751 1 ACCESS, INC. DBA AURORA COUNSELING - MOSINEE, 915 INDIANHEAD DR, MOSINEE, WI 54455 03/03/2020 12/31/2021 1 AURORA COMMUNITY COUNSELING- PHILLIPS, 171 CHESTNUT ST., PHILLIPS, WI 54555 01/01/2020 12/31/2021
2 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 345 FRENETTE DR STE 3, CHIPPEWA 01/01/2020 12/31/2021 FALLS, WI 54729 2 ACCESS, INC - LADYSMITH, 108 W. 2ND STREET N, LADYSMITH, WI 54848 01/01/2020 12/31/2021 2 ACCESS, INC. - SIREN, 24248 STATE HWY 35/70, UNIT D, SIREN, WI 54872 01/01/2020 12/31/2021
3 CADOTT MIDDLE SCHOOL AND HIGH SCHOOL, 426 MYRTLE ST, CADOTT, WI 54727 01/01/2020 12/31/2021 3 GRANTSBURG SCHOOL, 480 E JAMES AVE, GRANTSBURG, WI 54840 01/01/2020 12/31/2021 3 LADYSMITH ELEMENTARY SCHOOL, 115 E 6TH ST S, LADYSMITH, WI 54848 01/01/2020 12/31/2021 3 LADYSMITH MIDDLE/HIGH SCHOOL, 1700 EDGEWOOD AVE E, LADYSMITH, WI 54848 01/01/2020 12/31/2021 3 SPOONER ELEMENTARY SCHOOL, 1821 SCRIBNER ST, SPOONER, WI 54801 01/01/2020 12/31/2021 3 SPOONER HIGH SCHOOL, 801 COUNTY HIGHWAY A, SPOONER, WI 54801 01/01/2020 12/31/2021 3 SPOONER MIDDLE SCHOOL, 750 OAK ST, SPOONER, WI 54801 01/01/2020 12/31/2021 3 FLAMBEAU HIGH SCHOOL, N 4540 COUNTY HIGHWAY I, TONY, WI 54563 01/01/2020 12/31/2021
WHOLE LIFE SERVICES 3198
329 SOUTH RIVER ST, STE 301 GARY EHRICH Initial Cert: 04/23/2018 SPOONER, WI 54801 [email protected] Cert Eff: 04/01/2021 County: Washburn Phone:(715) 939-1248 Cert Exp: 03/31/2023 Surveyor: Rena Andersen Fax: (715) 645-0336
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 1 WHOLE LIFE SERVICES - SIREN, 24154 STATE ROAD 35/70, SIREN, WI 54872 04/01/2021 03/31/2023
09/28/2021 Page 196 of 222 Mental Health Program Directory By County, City, and Provider Name
WASHINGTON GERMANTOWN WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS 1199
W175 N11120 STONEWOOD DR ANDREA SEMMANN Initial Cert: 12/01/1987 GERMANTOWN, WI 53022 [email protected] Cert Eff: 06/01/2021 County: Washington Phone:(800) 438-1772 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (262) 345-5562
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 WLCFS - CHRISTIAN FAMILY SOLUTIONS, 112 PEACE LUTHERAN PKWY, HARTFORD, WI 53027 06/01/2021 10/31/2022 1 WLCFS - CHRISTIAN FAMILY SOLUTIONS, 9215 W WISCONSIN AVE, MILWAUKEE, WI 53226 06/01/2021 10/31/2022
3 ST JOHN'S GLENDALE LUTHERAN SCHOOL, 7877 N PORT WASHINGTON RD, GLENDALE, WI 53217 06/01/2021 10/31/2022 3 KETTLE MORAINE LUTHERAN HIGH SCHOOL, 3399 DIVISION RD, JACKSON, WI 53037 06/01/2021 10/31/2022 3 CROSS TRAINERS ACADEMY, 1530 W CENTER ST., MILWAUKEE, WI 53233 06/01/2021 10/31/2022 3 GARDEN HOMES LUTHERAN SCHOOL, 2450 W ROOSEVELT DR, MILWAUKEE, WI 53209 06/01/2021 10/31/2022 3 HOPE CHRISTIAN SCHOOL - FIDELIS, 4200 DOUGLAS AVE, MILWAUKEE, WI 53209 06/01/2021 10/31/2022 3 HOPE CHRISTIAN SCHOOL - FORTIS, 3601 N PORT WASHINGTON RD, MILWAUKEE, WI 53212 06/01/2021 10/31/2022 3 HOPE CHRISTIAN SCHOOL - PRIMA, 2345 N 25TH ST, MILWAUKEE, WI 53206 06/01/2021 10/31/2022 3 HOPE CHRISTIAN SCHOOL - SEMPER, 3040 W CAPITOL DR, MILWAUKEE, WI 53216 06/01/2021 10/31/2022 3 LUMIN - ST MARTINI LUTHERAN SCHOOL, 1520 S CESAR CHAVEZ DR, MILWAUKEE, WI 53204 06/01/2021 10/31/2022 3 MT LEBANON LUTHERAN SCHOOL - ALPHA, 6100 WEST HAMPTON AVE, MILWAUKEE, WI 53218 06/01/2021 10/31/2022 3 MT LEBANON LUTHERAN SCHOOL - OMEGA, 8444 W MELVINA ST, MILWAUKEE, WI 53222 06/01/2021 10/31/2022 3 MT. LEBANON - ALPHA 4K, 4809 N 60TH ST., MILWAUKEE, WI 53218 06/01/2021 10/31/2022 3 RISEN SAVIOR - EAST CAMPUS, 3909 W CLINTON AVE, MILWAUKEE, WI 53209 06/01/2021 10/31/2022 3 RISEN SAVIOR LUTHERAN SCHOOL, 9550 W BROWN DEER RD, MILWAUKEE, WI 53224 06/01/2021 10/31/2022 3 SALEM LUTHERAN HS, 6844 N 107TH STREET, MILWAUKEE, WI 53224 06/01/2021 10/31/2022 3 SHINING STAR CHRISTIAN SCHOOL - FAIRVIEW, 137 N 66TH ST, MILWAUKEE, WI 53213 06/01/2021 10/31/2022 3 SHINING STAR CHRISTIAN SCHOOL - WEST CAPITOL, 4050 N 95TH ST, MILWAUKEE, WI 53222 06/01/2021 10/31/2022 3 ST LUCAS LUTHERAN SCHOOL, 648 E DOVER ST, MILWAUKEE, WI 53207 06/01/2021 10/31/2022 3 ST MARCUS LUTHERAN SCHOOL - MAIN, 2215 N PALMER ST, MILWAUKEE, WI 53212 06/01/2021 10/31/2022 3 ST MARCUS LUTHERAN SCHOOL - NORTH, 2669 N RICHARDS ST, MILWAUKEE, WI 53212 06/01/2021 10/31/2022 3 ST PHILIP LUTHERAN SCHOOL, 3012 N HOLTON ST, MILWAUKEE, WI 53212 06/01/2021 10/31/2022 3 SHORELAND LUTHERAN HIGH SCHOOL, 9026 12TH STREET, SOMERS, WI 53171 06/01/2021 10/31/2022 3 CATHOLIC MEMORIAL HIGH SCHOOL, 601 E COLLEGE AVE, WAUKESHA, WI 53186 06/01/2021 10/31/2022 3 KINGDOM PREP HIGH SCHOOL, 2520 N WAUWATOSA AVE, WAUWATOSA, WI 53213 06/01/2021 10/31/2022
09/28/2021 Page 197 of 222 Mental Health Program Directory By County, City, and Provider Name
STILLWATER FAMILY INNOVATIONS INC 2903
6303 OSGOOD AVE DAVID RUNION Initial Cert: 05/01/2013 STILLWATER, MN 55082 [email protected] Cert Eff: 09/01/2020 County: Washington Phone:(651) 383-4800 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (651) 383-4801
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 FAMILY INNOVATIONS, INC EAU CLAIRE, 505 DEWEY STREET S, EAU CLAIRE, WI 54701 09/01/2020 04/30/2022
2 FAMILY INNOVATIONS, INC BALSAM LAKE, 215 MAIN STREET STE 205, BALSAM LAKE, WI 54810 09/01/2020 04/30/2022 2 FAMILY INNOVATIONS, INC HUDSON, 131 CARMICHAEL, HUDSON, WI 54016 09/01/2020 04/30/2022
FAMILYMEANS 1342
1875 NORTHWESTERN AVENUE, S. ERIN ROWLSON Initial Cert: 02/01/1989 STILLWATER, MN 55082 [email protected] Cert Eff: 01/01/2021 County: Washington Phone:(651) 439-4840 Cert Exp: 04/30/2022 Surveyor: Roderick Senn Fax: (651) 439-4894
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 3 EP ROCK ELEMENTARY SCHOOL, 340 13TH ST. N, HUDSON, WI 54016 01/01/2021 04/30/2022 3 HUDSON HIGH SCHOOL, 1501 VINE ST., HUDSON, WI 54016 01/01/2021 04/30/2022 3 HUDSON MIDDLE SCHOOL, 1300 CARMICHAEL RD, HUDSON, WI 54016 01/01/2021 04/30/2022 3 HUDSON PRAIRIE ELEMENTARY, 1400 CARMICHAEL ROAD, HUDSON, WI 54016 03/22/2021 04/30/2022 3 NEW RICHMOND HIGH SCHOOL, 650 RICHMOND WAY, NEW RICHMOND, WI 54017 01/01/2021 04/30/2022 3 NEW RICHMOND MIDDLE SCHOOL, 920 RILEY AVE, NEW RICHMOND, WI 54017 01/01/2021 04/30/2022 3 PRESCOTT HIGH SCHOOL, 1010 DEXTER ST, PRESCOTT, WI 54021 01/01/2021 04/30/2022 3 PRESCOTT MIDDLE SCHOOL, 125 N ELM STREET, PRESCOTT, WI 54021 01/01/2021 04/30/2022
WEST BEND AFFILIATED CLINICAL SERVICES INC 1017
111 E WASHINGTON STREET KELLI FEUCHT Initial Cert: 10/01/1984 WEST BEND, WI 53095 [email protected] Cert Eff: 10/01/2020 County: Washington Phone:(262) 338-2717 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (262) 338-9767
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 AFFILIATED CLINICAL SERVICES INC, 38 SELL DRIVE #B, HARTFORD, WI 53027 10/01/2020 06/30/2022
Non-Certified School Setting(s) Setting Begin/End Dates BADGER MIDDLE SCHOOL, 727 S 6TH AVE, ROOM #112, WEST BEND, WI 53095 10/01/2020 06/30/2022 WEST BEND EAST & WEST HIGH SCHOOL, 1305 E DECORAH RD, RM N 15, WEST BEND, WI 53095 10/01/2020 06/30/2022
09/28/2021 Page 198 of 222 Mental Health Program Directory By County, City, and Provider Name
ALARUS HEALTHCARE 3009
1622 CHESTNUT ST MICHAEL OWEN Initial Cert: 10/08/2013 WEST BEND, WI 53095 [email protected] Cert Eff: 04/01/2021 County: Washington Phone:(608) 799-5473 Cert Exp: 09/30/2022 Surveyor: Heather Lom Fax: (262) 377-6289
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2021 09/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 ALARUS HEALTHCARE - BEAVER DAM, 111 WARREN ST #2, BEAVER DAM, WI 53916 04/01/2021 09/30/2022 2 ALARUS HEALTHCARE - GRAFTON, 1971 WASHINGTON ST STE 200, GRAFTON, WI 53024 04/01/2021 09/30/2022
3 WEST BEND HIGH SCHOOL, 1305 E DECORAH RD, WEST BEND, WI 53095 04/01/2021 09/30/2022
KETTLE MORAINE COUNSELING 3234
400 W RIVER DR DEVONA MARSHALL Initial Cert: 11/28/2018 WEST BEND, WI 53090 [email protected] Cert Eff: 12/01/2019 County: Washington Phone:(262) 334-4340 Cert Exp: 11/30/2021 Surveyor: Heather Lom Fax: (262) 334-4341
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021
Tier Branch Location(s) Branch Begin/End Dates 1 KETTLE MORAINE COUNSELING, 700 RAYOVAC DR SUITE 320, MADISON, WI 53711 07/01/2021 11/30/2021 1 KETTLE MORAINE COUNSELING, 1446 HORICON ST, MAYVILLE, WI 53050 07/08/2021 11/30/2021
2 KETTLE MORAINE COUNSELING, W62N281 WASHINGTON AVE, CEDARBURG, WI 53012 12/01/2019 11/30/2021 2 KETTLE MORAINE COUNSILING, 7280 S 13TH ST SUITE 103, OAK CREEK, WI 53154 12/01/2019 11/30/2021
Non-Certified School Setting(s) Setting Begin/End Dates SLINGER SCHOOL DISTRICT, 207 POLK ST, SLINGER, WI 53086 12/01/2019 11/30/2021 SLINGER SCHOOL DISTRICT, 521 OLYMPIC DR, SLINGER, WI 53086 12/01/2019 11/30/2021 MCLANE ELEMENTARY SCHOOL, 833 CHESTNUT ST, WEST BEND, WI 53095 12/01/2019 11/30/2021 SILVERBROOK MIDDLE SCHOOL, 120 N SILVERBROOK DR, WEST BEND, WI 53095 12/01/2019 11/30/2021
WASHINGTON COUNTY MENTAL HEALTH CENTER 1968
333 E WASHINGTON ST #2100 DOUG BREY Initial Cert: 10/01/1975 WEST BEND, WI 53095 [email protected] Cert Eff: 05/01/2021 County: Washington Phone:(262) 335-4554 Cert Exp: 04/30/2023 Surveyor: Heather Lom Fax: (262) 335-6827 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 WASHINGTON COUNTY SHARED CALL SERVICE 01/01/2020 WASHINGTON COUNTY SHARED CRISIS STABILIZATION SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
09/28/2021 Page 199 of 222 Mental Health Program Directory By County, City, and Provider Name
WASHINGTON COUNTY MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM 2303
333 E. WASHINGTON ST SUITE 2100 LISA SCHOBERT Initial Cert: 10/01/1975 WEST BEND, WI 53095 [email protected] Cert Eff: 05/01/2021 County: Washington Phone:(262) 335-4602 Cert Exp: 04/30/2023 Surveyor: Heather Lom Fax: (262) 335-6827
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2021 04/30/2023 NO BRANCH LOCATIONS
WASHINGTON COUNTY MENTAL HEALTH CENTER COMPREHENSIVE COMMUNITY SERVICES 2580
333 E WASHINGTON STREET, #2100 LISA SCHOBERT Initial Cert: 03/01/2005 WEST BEND, WI 53095 [email protected] Cert Eff: 03/01/2020 County: Washington Phone:(262) 335-4602 Cert Exp: 02/28/2022 Surveyor: Heather Lom Fax: (262) 335-6827
CCS Affiliaton:LAKESHORE RECOVERY COLLABORATIVE V2 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2020 02/28/2022 NO BRANCH LOCATIONS
09/28/2021 Page 200 of 222 Mental Health Program Directory By County, City, and Provider Name
WAUKESHA BROOKFIELD ASCENSION SE WI HOSPITAL, INC ST JOSEPH BEHAVIORAL HEALTH II 2654
13950 W CAPITOL DR 2ND FLOOR CAROL HESS Initial Cert: 07/22/2005 BROOKFIELD, WI 53005 [email protected] Cert Eff: 09/01/2021 County: Waukesha Phone:(414) 874-6288 Cert Exp: 08/31/2023 Surveyor: Kelley Clark Fax: (414) 874-6291
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2021 08/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 ELMBROOK MEMORIAL HOSPITAL, 19333 W NORTH AVE #303, BROOKFIELD, WI 53045 09/01/2021 08/31/2023
CENTER FOR BEHAVIORAL MEDICINE 3290
250 N SUNNYSLOPE ROAD, STE 203 NEAL MOGLOWSKY Initial Cert: 02/20/2020 BROOKFIELD, WI 53005 [email protected] Cert Eff: 09/01/2021 County: Waukesha Phone:(262) 782-2828 Cert Exp: 02/28/2023 Surveyor: Kelley Clark Fax: (262) 782-6937
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 02/28/2023 NO BRANCH LOCATIONS
CORNERSTONE COUNSELING SERVICES, INC. 1237
16535 W. BLUEMOUND ROAD, #200 SANDY ADAMS Initial Cert: 03/01/1993 BROOKFIELD, WI 53005 [email protected] Cert Eff: 03/01/2020 County: Waukesha Phone:(262) 789-1191 Cert Exp: 02/28/2022 Surveyor: Kelley Clark Fax: (262) 821-6180
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2020 02/28/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2020 02/28/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CORNERSTONE COUNSELING SERVICES, INC., 5555 N PORT WASHINGTON ROAD, #200, GLENDALE, 03/01/2020 02/28/2022 WI 53217 2 CORNERSTONE COUNSELING SERVICES, INC., 4811 S 76TH ST #208, GREENFIELD, WI 53220 03/01/2020 02/28/2022 2 CORNERSTONE COUNSELING SERVICES, INC., 11649 N PORT WASHINGTON RD, #201, MEQUON, WI 03/01/2020 02/28/2022 53092 2 CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 350, MILWAUKEE, 03/01/2020 02/28/2022 WI 53207 2 CORNERSTONE COUNSELING SERVICES, INC., 10850 W PARK PLACE, #100, MILWAUKEE, WI 53224 03/01/2020 02/28/2022 2 CORNERSTONE COUNSELING SERVICES, INC., 400 BAY VIEW ROAD, SUITE C, MUKWONAGO, WI 03/01/2020 02/28/2022 53149 2 CORNERSTONE COUNSELING SERVICES, INC., 1230 CORPORATE CENTER DR, STE 100, 03/01/2020 02/28/2022 OCONOMOWOC, WI 53066 2 CORNERSTONE COUNSELNG SVS, INC, 1143 WARWICK WAY, RACINE, WI 53406 04/01/2020 02/28/2022 2 CORNERSTONE COUNSELING SERVICES, INC., 741 N GRAND AVENUE, #302, WAUKESHA, WI 53186 03/01/2020 02/28/2022
3 MUKWONAGO HIGH SCHOOL, 605 W VETERANS WAY, MUKWONAGO, WI 53149 03/01/2020 02/28/2022
09/28/2021 Page 201 of 222 Mental Health Program Directory By County, City, and Provider Name
FAMILY OPTIONS COUNSELING, LLC 2692
3505 NORTH 124TH ST KIMBERLY YOUNG Initial Cert: 11/02/2006 BROOKFIELD, WI 53005 [email protected] Cert Eff: 11/01/2019 County: Waukesha Phone:(414) 431-4444 Cert Exp: 10/31/2021 Surveyor: Kelley Clark Fax: (414) 431-0858
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
MATTERS OF THE SPIRIT, LLC 3062
12645 W BURLEIGH RD #19 PASTOR TINA SANFORD Initial Cert: 01/01/2015 BROOKFIELD, WI 53005 [email protected] Cert Eff: 06/01/2021 County: Waukesha Phone:(414) 788-3623 Cert Exp: 05/31/2023 Surveyor: Kelley Clark Fax: (414) 488-2969
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 08/01/2021 05/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2021 05/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2021 05/31/2023 NO BRANCH LOCATIONS
WISCONSIN EARLY AUTISM PROJECT, INC 2461
150 N. SUNNYSLOPE RD SUITE 100 KIMBERLY WROBLEWSKI Initial Cert: 05/20/2003 BROOKFIELD, WI 53005 [email protected] Cert Eff: 09/01/2020 County: Waukesha Phone:(262) 432-5660 Cert Exp: 05/31/2022 Surveyor: Kelley Clark Fax: (262) 432-5666
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2020 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 WISCONSIN EARLY AUTISM PROJECT, 1413 WINCHESTER WAY, ALTOONA, WI 54720 03/29/2021 05/31/2022 1 WISCONSIN EARLY AUTISM PROJECT DEPERE, 1141 W MAIN AVE STE 201, DE PERE, WI 54115 09/01/2020 05/31/2022 1 WISCONSIN EARLY AUTISM PROJECT MADISON, 1210 FOURIER DR, MADISON, WI 53717 09/01/2020 05/31/2022
WLCFS DBA CHRISTIAN FAMILY SOLUTIONS 3177
16535 W BLUEMOUND RD SUITE 305 ANDREA SEMMANN Initial Cert: 07/05/2017 BROOKFIELD, WI 53005 [email protected] Cert Eff: 08/01/2020 County: Waukesha Phone:(800) 438-1772 Cert Exp: 07/31/2022 Surveyor: Kelley Clark Fax: (262) 345-5562
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 08/01/2020 07/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 WISCONSIN LUTHERAN COLLEGE, 8800 BLUEMOUND ROAD, MILWAUKEE, WI 53226 08/01/2020 07/31/2022
3 LAKESIDE LUTHERAN HIGH SCHOOL, 231 WOODLAND BRANCH RD, LAKE MILLS, WI 53551 08/01/2020 07/31/2022 3 LUTHER PREPARATORY SCHOOL, 1300 WESTERN AVE, WATERTOWN, WI 53094 08/01/2020 07/31/2022
09/28/2021 Page 202 of 222 Mental Health Program Directory By County, City, and Provider Name
ELM GROVE APPLIED THERAPIES AND WELLNESS CENTER SC 2734
12970 W BLUEMOUND RD, #304 TRISHA WOLLIN Initial Cert: 05/30/2007 ELM GROVE, WI 53122 [email protected] Cert Eff: 01/01/2021 County: Waukesha Phone:(414) 302-1233 Cert Exp: 05/31/2022 Surveyor: Kelley Clark Fax: (414) 302-1234
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022 NO BRANCH LOCATIONS
ELMBROOK FAMILY COUNSELING CENTER 1297
13000 W BLUEMOUND RD #300 HOWARD J HAVEN Initial Cert: 03/01/1978 ELM GROVE, WI 53122 [email protected] Cert Eff: 04/01/2021 County: Waukesha Phone:(262) 785-9188 Cert Exp: 03/31/2023 Surveyor: Kelley Clark Fax: (262) 785-0644
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 03/31/2023 NO BRANCH LOCATIONS MENOMONEE FALLS DOMINION BEHAVIORAL HEALTH SERVICES, LLC 2688
W132 N6303 MARACH ROAD FRANCINE DIXON Initial Cert: 11/01/2006 MENOMONEE FALLS, WI 53051 [email protected] Cert Eff: 11/01/2019 County: Waukesha Phone:(262) 751-7507 Cert Exp: 10/31/2021 Surveyor: Kelley Clark Fax: (262) 252-7567
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
FROEDTERT & THE MEDICAL COLLEGE OF WI-COMMUNITY MEMORIAL HOSPITAL 2076
W180 N8085 TOWN HALL ROAD BARBARA JONES Initial Cert: 10/01/1982 MENOMONEE FALLS, WI 53051 [email protected] Cert Eff: 07/01/2021 County: Waukesha Phone:(262) 257-3580 Cert Exp: 08/31/2022 Surveyor: Kelley Clark Fax: (262) 257-2570
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2021 08/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2021 08/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 08/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2021 08/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2021 08/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 203 of 222 Mental Health Program Directory By County, City, and Provider Name
FROEDTERT PHYSICIANS PARTNERS 1579
W129 N 7055 NORTHFIELD DR 3RD FL BLDG A LUCAS GRANCORVITZ Initial Cert: 02/01/1981 MENOMONEE FALLS, WI 53051 [email protected] Cert Eff: 11/01/2019 County: Waukesha Phone:(262) 502-3300 Cert Exp: 10/31/2021 Surveyor: Kelley Clark Fax: (262) 532-9585
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 FROEDTERT AND MED COLLEGE PHY PARTNERS SUNNYSLOPE, 1350 SUNNYSLOPE ROAD, 11/01/2019 10/31/2021 BROOKFIELD, WI 53005 1 FROEDTERT PHYSICIANS PARTNERS, 110 LONE OAK LANE, HARTFORD, WI 53027 11/01/2019 10/31/2021
2 FROEDERT PHYSICIANS PARTNERS, W168 N11237 WESTERN AVENUE, GERMANTOWN, WI 53022 11/01/2019 10/31/2021 2 FROEDTERT COMMUNITY PHYSICIANS SARGEANT CLINIC, 840 N 87TH ST, MILWAUKEE, WI 53226 11/01/2019 10/31/2021 2 FROEDTERT COMMUNITY PHYSICIANS MOORLAND RESERVE, 4805 S. MOORLAND RD, NEW 11/01/2019 10/31/2021 BERLIN, WI 53151 2 FROEDTERT COMMUNITY PHYSICIANS LINCOLN AVE HEALTH, 11211 W LINCOLN AVE, WEST ALLIS, 11/01/2019 10/31/2021 WI 53227
MUSKEGO AURORA BEHAVIORAL HEALTH-MUSKEGO WEST 1650
S74W16775 JANESVILLE RD DON NEUMANN Initial Cert: 05/02/1994 MUSKEGO, WI 53150 [email protected] Cert Eff: 05/01/2021 County: Waukesha Phone:(414) 773-4374 Cert Exp: 04/30/2023 Surveyor: Connie Knezic Fax: (414) 529-9188
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA BEHAVIORAL HEALTH CENTER-FRANKLIN, 9200 W LOOMIS RD, STE 217, FRANKLIN, WI 05/01/2021 04/30/2023 53132 2 AURORA BEHAVIORAL HEALTH CENTER-84 SOUTH, 9000 SURA LANE, GREENFIELD, WI 53228 05/01/2021 04/30/2023 2 AURORA BEHAVIORAL HEALTH CENTER-LAYTON, 2000 E LAYTON AVE, STE 250, SAINT FRANCIS, WI 05/01/2021 04/30/2023 53235 2 AURORA BEHAVIORAL HEALTH CENTER-LAKESHORE, 3611 CHICAGO AVE, SOUTH MILWAUKEE, WI 05/01/2021 04/30/2023 53172
AURORA PSYCHIATRIC HOSPITAL MUSKEGO PROGRAMS 3162
S74W16775 JANESVILLE ROAD JAMIE SURFUS-LEWISTON Initial Cert: 12/14/2016 MUSKEGO, WI 53150 [email protected] Cert Eff: 01/01/2020 County: Waukesha Phone:(414) 422-2400 Cert Exp: 12/31/2021 Surveyor: Kelley Clark Fax: (414) 422-2190
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 01/01/2020 12/31/2021 CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 204 of 222 Mental Health Program Directory By County, City, and Provider Name
OCONOMOWOC ROGERS MEMORIAL HOSPITAL 1810
34700 VALLEY ROAD MAEVE O'NEILL Initial Cert: 08/01/1988 OCONOMOWOC, WI 53066 [email protected] Cert Eff: 11/01/2019 County: Waukesha Phone:(262) 646-4411 Cert Exp: 10/31/2021 Surveyor: Kelley Clark Fax: (262) 303-4337
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 11/01/2019 10/31/2021 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 11/01/2019 10/31/2021 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2019 10/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL - SILVER LAKE OUTPATIENT CENTER 3099
1205 CORPORATE CENTER DRIVE MAEVE O'NEILL Initial Cert: 09/28/2015 OCONOMOWOC, WI 53066 [email protected] Cert Eff: 11/01/2020 County: Waukesha Phone:(262) 464-1144 Cert Exp: 10/31/2022 Surveyor: Kelley Clark Fax: (262) 646-1049
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 11/01/2020 10/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
ROGERS MEMORIAL HOSPITAL, INC 3254
1230 CORPORATE CENTER DR MAEVEO'NEILL Initial Cert: 06/18/2019 OCONOMOWOC, WI 53066 [email protected] Cert Eff: 11/01/2020 County: Waukesha Phone:(262) 303-2131 Cert Exp: 10/31/2022 Surveyor: Kelley Clark Fax: (262) 567-3490
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 11/01/2020 10/31/2022 NO BRANCH LOCATIONS WAUKESHA A HEALING CENTER/EFFICIENCY MANAGEMENT CONSULTING, S.C. 1001
20860 WATERTOWN ROAD SHELLEY P. Initial Cert: 09/01/1987 WAUKESHA, WI 53186 [email protected] Cert Eff: 01/01/2020 County: Waukesha Phone:(262) 821-6117 Cert Exp: 12/31/2021 Surveyor: Anastasia E. Vega Fax: (262) 821-6119
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
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AURORA BEHAVIORAL HEALTH CENTER - WAUKESHA 2386
W231 N1440 CORPORATE CT #310 KATHRYN GRAHAM Initial Cert: 04/01/2002 WAUKESHA, WI 53186 [email protected] Cert Eff: 01/01/2021 County: Waukesha Phone:(414) 773-4374 Cert Exp: 04/30/2022 Surveyor: Anastasia E. Vega Fax: (414) 454-6450
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 04/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 04/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 AURORA BEHAVIORAL HEALTH CENTER-MENOMONEE FALLS, W84W16889 MENOMONEE AVE, 01/01/2021 04/30/2022 MENOMONEE FALLS, WI 53051 2 AURORA BEHAVIORAL HEALTH CENTER-BROOKFIELD, 16985 WEST BLUEMOUND ROAD, 01/01/2021 04/30/2022 BROOKFIELD, WI 53005 2 AURORA BEHAVIORAL HEALTH CENTER - HARTFORD, 1640 E SUMNER ST, HARTFORD, WI 53027 01/01/2021 04/30/2022 2 AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, 14555 W NATIONAL AVE, NEW BERLIN, WI 01/01/2021 04/30/2022 53151 2 AURORA BEHAVIORAL HEALTH CENTER-SUMMIT, 36500 AURORA DRIVE, SUMMIT, WI 53066 01/01/2021 04/30/2022 2 AURORA BEHAVIORAL HEALTH CENTER - WEST BEND, 205 VALLEY AVE, WEST BEND, WI 53095 01/01/2021 04/30/2022
BETHANY CHRISTIAN SERVICES OF WI 3022
N14W23755 STONE RIDGE DR #265 JENNIFER SCHMEICHEL Initial Cert: 06/01/2014 WAUKESHA, WI 53188 [email protected] Cert Eff: 01/01/2021 County: Waukesha Phone:(262) 547-6557 Cert Exp: 05/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 547-3644
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2021 05/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 05/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 BETHANY RECOVERY CENTER, 1331 CAPITOL DRIVE, OCONOMOWOC, WI 53066 01/01/2021 05/31/2022
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. 1134
717 N EAST AVE RICARDO CISNEROS Initial Cert: 06/01/1981 WAUKESHA, WI 53186 [email protected] Cert Eff: 05/01/2021 County: Waukesha Phone:(262) 547-2463 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 547-8002
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 CATHOLIC CHARITIES - WEST BEND, 724 ELM STREET, WEST BEND, WI 53095 09/09/2021 04/30/2023
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FAMILY SERVICE OF WAUKESHA 1340
101 W BROADWAY, 2ND FLOOR LAURA CHERONE Initial Cert: 09/01/1977 WAUKESHA, WI 53186 [email protected] Cert Eff: 02/01/2020 County: Waukesha Phone:(262) 547-5567 Cert Exp: 01/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 547-1608
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 FAMILY SERVICE OF WAUKESHA, 175 EAST WISCONSIN AVE STE H, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 2 FAMILY SERVICE OF WAUKESHA, 726 N EAST AVENUE, WAUKESHA, WI 53186 02/01/2020 01/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates DOUSMAN ELEMENTARY SCHOOL, 341 E OTTAWA AVE, DOUSMAN, WI 53118 02/01/2020 01/31/2022 ARROWHEAD UNION HIGH SCHOOL - NORTH, 800 NORTH AVE, HARTLAND, WI 53029 02/01/2020 01/31/2022 ARROWHEAD UNION HIGH SCHOOL - SOUTH, 700 NORTH AVE, HARTLAND, WI 53029 02/01/2020 01/31/2022 IXONIA ELEMENTARY SCHOOL, N8425 NORTH STREET, IXONIA, WI 53036 02/01/2020 01/31/2022 GREENLAND ELEMENTARY SCHOOL, 440 E COOLIDGE ST, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 MEADOW VIEW ELEMENTARY SCHOOL, W360 N7077 BROWN ST, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 NATURE HILL INTERMEDIATE SCHOOL, 850 LAKE DRIVE, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 PARK LAWN ELEMENTARY SCHOOL, 300 PARKLAWN ST, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 SUMMIT ELEMENTARY SCHOOL, 1680 VALLEY ROAD, OCONOMOWOC, WI 53066 02/01/2020 01/31/2022 WALES ELEMENTARY SCHOOL, 219 N OAK CREST DR, WALES, WI 53183 02/01/2020 01/31/2022 BANTING ELEMENTARY SCHOOL, 2019 BUTLER DR, WAUKESHA, WI 53186 02/01/2020 01/31/2022 BLAIR ELEMENTARY SCHOOL, 301 HYDE PARK AVE, WAUKESHA, WI 53186 02/01/2020 01/31/2022 HADFIELD ELEMENTARY SCHOOL, 733 LINDEN ST, WAUKESHA, WI 53186 02/01/2020 01/31/2022 HORNING MIDDLE SCHOOL, 2000 WOLF RD, WAUKESHA, WI 53189 02/01/2020 01/31/2022 SOUTH HIGH SCHOOL, 222 MAPLE AVE, WAUKESHA, WI 53186 02/01/2020 01/31/2022 WHITTIER ELEMENTARY SCHOOL, 1103 S EAST AVENUE, WAUKESHA, WI 53186 02/01/2020 01/31/2022 MADISON ELEMENTARY SCHOOL, 9925 W GLENDALE, WAUWATOSA, WI 53225 02/01/2020 01/31/2022
HOPE FOR A BETTER TOMORROW 3107
2607 N GRANDVIEW BLVD, #110 DR. SHEILA GISSIBL Initial Cert: 12/01/2015 WAUKESHA, WI 53188 [email protected] Cert Eff: 12/01/2020 County: Waukesha Phone:(262) 313-8339 Cert Exp: 11/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 910-1653
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022 NO BRANCH LOCATIONS
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PROHEALTH CARE MEDICAL ASSOCIATES, INC BEHAVIORAL HEALTH SERVICES 1974
721 AMERICAN AVENUE #501 ANDREW GRZYBOWSKI Initial Cert: 06/01/1986 WAUKESHA, WI 53188 [email protected] Cert Eff: 01/01/2020 County: Waukesha Phone:(262) 928-4036 Cert Exp: 12/31/2021 Surveyor: Anastasia E. Vega Fax: (262) 928-5096
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 1 PHCMA, INC BEHAVIORAL HLTH SVS - DELAFIELD, 2750 GOLF ROAD, DELAFIELD, WI 53018 01/01/2020 12/31/2021 1 PHCMA, INC BEHAVIORAL HLTH SVS - WATERTOWN, 109 AIR PARK DR, WATERTOWN, WI 53094 01/01/2020 12/31/2021 1 PHCMA, INC BEHAVIORAL HLTH SVS - SENIOR HEALTH SVS, 721 AMERICAN AVE #508, WAUKESHA, 04/27/2021 12/31/2021 WI 53188 2 PHCMA, INC BEHAVIORAL HLTH SVS - BROOKFIELD, 195 DISCOVERY DR, BROOKFIELD, WI 53045 01/01/2020 12/31/2021 2 PHCMA, INC BEHAVIORAL HLTH SVS - HARTLAND, 1500 WALNUT RIDGE DR, HARTLAND, WI 53029 01/01/2020 12/31/2021 2 PHCMA, INC BEHAVIORAL HLTH SVS - MUKWONAGO, 240 WEST MAPLE AVE, MUKWONAGO, WI 01/01/2020 12/31/2021 53149 2 PHCMA, INC BEHAVIORAL HLTH SVS - MUSKEGO, S69 W15636 JANESVILLE RD, MUSKEGO, WI 01/01/2020 12/31/2021 53150 2 PHCMA, INC BEHAVIORAL HLTH SVS - NEW BERLIN, 13900 WEST NATIONAL AVE, NEW BERLIN, WI 01/01/2020 12/31/2021 53151 2 PHCMA, INC BEHAVIORAL HLTH SVS - OCONOMOWOC, 1185 CORPORATE CENTER DR SUITE 175 - 01/01/2020 12/31/2021 320, OCONOMOWOC, WI 53066 2 PHCMA, INC BEHAVIORAL HLTH SVS - SUSSEX, N57 W24950 N CORPORATE CIRCLE, SUSSEX, WI 01/01/2020 12/31/2021 53089 2 PHCMA, INC BEHAVIORAL HLTH SVS - AMERICAN AVE #406, 721 AMERICAN AVE #406, WAUKESHA, 04/27/2021 12/31/2021 WI 53188 2 PHCMA, INC BEHAVIORAL HLTH SVS - BARSTOW ST, 210 NW BARSTOW ST, WAUKESHA, WI 53188 01/01/2020 12/31/2021 2 PHCMA, INC BEHAVIORAL HLTH SVS - BIG BEND RD, 2130 BIG BEND ROAD, WAUKESHA, WI 53189 01/01/2020 12/31/2021 2 PHCMA, INC BEHAVIORAL HLTH SVS - MORELAND BLVD., 717 WEST MORELAND BLVD, WAUKESHA, 01/01/2020 12/31/2021 WI 53188 2 PHCMA, INC BEHAVIORAL HLTH SVS - PEWAUKEE, N16W24131 RIVERWOOD DR., WAUKESHA, WI 01/01/2020 12/31/2021 53188 3 ST JOHNS NW MILITARY ACADEMY, 1101 GENESEE ST, DELAFIELD, WI 53018 01/23/2020 12/31/2021
STRESS MANAGEMENT & MENTAL HEALTH CLINICS 3221
2717 N GRANDVIEW BLVD #303 JOHN WEAVER Initial Cert: 10/01/2018 WAUKESHA, WI 53188 [email protected] Cert Eff: 10/01/2021 County: Waukesha Phone:(262) 544-6486 Cert Exp: 09/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 544-6377
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
WAUKESHA COUNTY DHHS CCS 3042
1501 AIRPORT ROAD COURTNEY MCELMEEL Initial Cert: 07/01/2014 WAUKESHA, WI 53188 [email protected] Cert Eff: 04/01/2021 County: Waukesha Phone:(262) 548-7978 Cert Exp: 06/30/2022 Surveyor: Anastasia E. Vega Fax: (262) 896-8180
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL POPULATION-BASED DHS 36 04/01/2021 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 WAUKESHA CO DHHS HUMAN SERVICES CENTER, 514 RIVERVIEW AVE, WAUKESHA, WI 53188 04/01/2021 06/30/2022
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WAUKESHA COUNTY HEALTH AND HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM 1972
1501 AIRPORT ROAD BRAD HAAS Initial Cert: 10/01/1990 WAUKESHA, WI 53188 [email protected] Cert Eff: 10/01/2019 County: Waukesha Phone:(262) 548-7950 Cert Exp: 09/30/2021 Surveyor: Anastasia E. Vega Fax: (262) 896-8046
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2019 09/30/2021 NO BRANCH LOCATIONS
WAUKESHA COUNTY MENTAL HEALTH CENTER 1971
1501 AIRPORT ROAD JEFFRY LEWIS Initial Cert: 04/01/1987 WAUKESHA, WI 53188 [email protected] Cert Eff: 01/01/2021 County: Waukesha Phone:(262) 548-7950 Cert Exp: 03/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 896-8046
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2021 03/31/2022 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 03/05/2021 03/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 03/31/2022 NO BRANCH LOCATIONS
WAUKESHA COUNTY, DBA WAUKESHA COUNTY DHHS 1970
514 RIVERVIEW AVENUE DANIELLE BIRDEAU Initial Cert: 04/01/1984 WAUKESHA, WI 53188 [email protected] Cert Eff: 05/01/2021 County: Waukesha Phone:(262) 548-7666 Cert Exp: 04/30/2023 Surveyor: Anastasia E. Vega Fax: (262) 548-7656 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 SINGLE COUNTY CCS REGION - WAUKESHA 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2021 04/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2021 04/30/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2021 04/30/2023
Tier Branch Location(s) Branch Begin/End Dates 2 WAUKESHA COUNTY MENTAL HEALTH CENTER, 1501 AIRPORT RD, WAUKESHA, WI 53188 05/01/2021 04/30/2023
WAUKESHA MEMORIAL HOSPITAL 1976
725 AMERICAN AVENUE JESSICA GRZYBOWSKI Initial Cert: 06/01/1986 WAUKESHA, WI 53188 [email protected] Cert Eff: 01/01/2021 County: Waukesha Phone:(262) 928-2324 Cert Exp: 12/31/2022 Surveyor: Anastasia E. Vega Fax: (262) 928-5382
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 01/01/2021 12/31/2022 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2021 12/31/2022 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2021 12/31/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2021 12/31/2022 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2021 12/31/2022 NO BRANCH LOCATIONS
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WAUPACA NEW LONDON RAWHIDE YOUTH & FAMILY COUNSELING SERVICES 2750
E7475 RAWHIDE ROAD HEATHER KAHL Initial Cert: 08/23/2007 NEW LONDON, WI 54961 [email protected] Cert Eff: 09/01/2021 County: Waupaca Phone:(920) 531-2647 Cert Exp: 08/31/2023 Surveyor: Heather Lom Fax: (920) 531-2662
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 1 RAWHIDE - MILWAUKEE URBAN STABLES, 143 E LINCOLN AVE, MILWAUKEE, WI 53207 09/01/2021 08/31/2023 1 RAWHIDE - BEAMING, INC, 2692 COUNTY RD GG, NEENAH, WI 54956 09/01/2021 08/31/2023
2 RAWHIDE - OUTAGAMIE, 446 WESTHILL BLVD STE 6, APPLETON, WI 54914 09/01/2021 08/31/2023 2 RAWHIDE - FOND DU LAC, N5682 CTH K, FOND DU LAC, WI 54937 09/01/2021 08/31/2023 2 RAWHIDE - GLENDALE, 5555 N PORT WASHINGTON RD STE 207, GLENDALE, WI 53217 09/01/2021 08/31/2023 2 RAWHIDE - GREEN BAY, 926 WILLARD DR, STE 228, GREEN BAY, WI 54303 09/01/2021 08/31/2023 2 RAWHIDE - SHIOCTON, N5367 MAYFLOWER ROAD, SHIOCTON, WI 54170 09/01/2021 08/31/2023
Non-Certified School Setting(s) Setting Begin/End Dates EVANS ELEMENTARY SCHOOL, 140 S PETERS AVE, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 PIER ELEMENTARY SCHOOL, 295 OLD PIONEER RD, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 ROBERTS ELEMENTARY SCHOOL, 270 CANDY LANE, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 SABISH MIDDLE SCHOOL, 100 N PETERS AVE, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 STEM ACADEMY, 401 S MILITARY RD, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 WOODWORTH MIDDLE SCHOOL, 101 MORNINGSIDE DR, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN, MILWAUKEE, WI 53233 09/01/2021 08/31/2023 NEW LONDON HIGH SCHOOL, 1700 KLATT ROAD, NEW LONDON, WI 54961 09/01/2021 08/31/2023 NEW LONDON MIDDLE SCHOOL, 1000 W WASHINGTON ST, NEW LONDON, WI 54961 09/01/2021 08/31/2023 SUGAR BUSH ELEMENTARY SCHOOL, W10736 COUNTY RD WW, NEW LONDON, WI 54961 09/01/2021 08/31/2023 BESSIE ALLEN MIDDLE SCHOOL, 305 MCKINLEY ST, NORTH FOND DU LAC, WI 54937 09/01/2021 08/31/2023 FRIENDSHIP LEARNING CENTER, 1098 PROSPECT AVE, NORTH FOND DU LAC, WI 54937 09/01/2021 08/31/2023 HORACE MANN HIGH SCHOOL, 325 MCKINLEY ST, NORTH FOND DU LAC, WI 54937 09/01/2021 08/31/2023
WAUPACA WAUPACA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP 2123
811 HARDING STREET TINA LINTNER Initial Cert: 12/01/1981 WAUPACA, WI 54981 [email protected] Cert Eff: 10/01/2020 County: Waupaca Phone:(715) 258-6302 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (715) 258-6409
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
09/28/2021 Page 210 of 222 Mental Health Program Directory By County, City, and Provider Name
WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CCS 3109
811 HARDING ST TINA LINTNER Initial Cert: 03/01/2016 WAUPACA, WI 54981 [email protected] Cert Eff: 01/01/2020 County: Waupaca Phone:(715) 258-6300 Cert Exp: 12/31/2021 Surveyor: Heather Lom Fax: (715) 258-6409
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 01/01/2020 12/31/2021 NO BRANCH LOCATIONS
WAUPACA COUNTY DEPT OF HEALTH AND HUMAN SERVICES 1977
811 HARDING STREET KAY SAARINEN-BARR Initial Cert: 12/01/1981 WAUPACA, WI 54981 [email protected] Cert Eff: 07/01/2021 County: Waupaca Phone:(715) 258-6302 Cert Exp: 06/30/2023 Surveyor: Heather Lom Fax: (715) 258-6409 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 OUTAGAMIE COUNTY SHARED CALL SERVICE 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2021 06/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2021 06/30/2023 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2021 06/30/2023
Tier Branch Location(s) Branch Begin/End Dates 1 MAMA'S HOUSE OF HOPE, 121 E RAMSDELL ST., MARION, WI 54950 07/01/2021 06/30/2023 1 WAUPACA CO DEPT OF HEALTH & HUMAN SERV, 1405 MILL ST, NEW LONDON, WI 54961 07/01/2021 06/30/2023
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WAUSHARA WAUTOMA FAMILY HEALTH LA CLINICA 3191
400 SOUTH TOWNLINE ROAD LAURA WALDVOGEL Initial Cert: 03/05/2018 WAUTOMA, WI 54982 [email protected] Cert Eff: 03/01/2021 County: Waushara Phone:(920) 787-5514 Cert Exp: 02/28/2023 Surveyor: Heather Lom Fax: (920) 787-4737
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023 NO BRANCH LOCATIONS
WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES 1980
230 W PARK STREET GREGORY ERICKSON Initial Cert: 10/01/1975 WAUTOMA, WI 54982 [email protected] Cert Eff: 11/01/2020 County: Waushara Phone:(920) 787-6600 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 787-0421
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 CSAS-PREVENTION DHS 75.04 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 3 BERLIN HIGH SCHOOL, 222 MEMORIAL DRIVE, BERLIN, WI 54923 11/01/2020 10/31/2022 3 TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 54966 11/01/2020 10/31/2022 3 WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI 54982 11/01/2020 10/31/2022 3 WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI 53964 11/01/2020 10/31/2022 3 WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI 54984 11/01/2020 10/31/2022
WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CRISIS PROGRAM 3275
312 W PARK STREET GREGORY ERICKSON Initial Cert: 11/01/2019 WAUTOMA, WI 54982 [email protected] Cert Eff: 11/01/2020 County: Waushara Phone:(920) 787-6600 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 787-0465 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 CRISIS DIVERSION FACILITIES SHARED SERVICES 01/01/2020
Services Adm Code Service Begin/End Dates MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CSP 1979
230 W PARK STREET TONI MORGAN-JONES Initial Cert: 08/01/1997 WAUTOMA, WI 54982 [email protected] Cert Eff: 11/01/2020 County: Waushara Phone:(920) 787-6600 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 787-0421
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 212 of 222 Mental Health Program Directory By County, City, and Provider Name
WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES 2618
312 W PARK STREET GREGORY ERICKSON Initial Cert: 10/19/2005 WAUTOMA, WI 54982 [email protected] Cert Eff: 11/01/2020 County: Waushara Phone:(920) 787-6600 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 787-0421
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 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 213 of 222 Mental Health Program Directory By County, City, and Provider Name
WINNEBAGO MENASHA CATHOLIC CHARITIES DIOCESE OF GREEN BAY, INC. 1138
1475 OPPORTUNITY WAY CELIA J GARDNER Initial Cert: 01/26/1988 MENASHA, WI 54952 [email protected] Cert Eff: 02/01/2020 County: Winnebago Phone:(920) 734-2601 Cert Exp: 01/31/2022 Surveyor: Heather Lom Fax: (920) 437-4067
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022 NO BRANCH LOCATIONS
THE COUNSELING CLINIC-FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. 1333
1810 APPLETON ROAD KATHERINE RAPPEL Initial Cert: 03/01/1983 MENASHA, WI 54952 [email protected] Cert Eff: 12/01/2020 County: Winnebago Phone:(920) 739-4226 Cert Exp: 11/30/2022 Surveyor: Heather Lom Fax: (920) 739-7639
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2020 11/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 PARKVIEW LEARNING CENTER, 217 E KIMBERLY AVE, KIMBERLY, WI 54136 12/01/2020 11/30/2022
3 SUNRISE ELEMENTARY SCHOOL, N9363 EXPLORATION DR, APPLETON, WI 54915 12/01/2020 11/30/2022 3 WOODLAND ELEMENTARY SCHOOL, N9085 N COOP RD, APPLETON, WI 54915 12/01/2020 11/30/2022 3 WOODLAND INTERMEDIATE SCHOOL, N9085 N COOP RD, APPLETON, WI 54915 12/01/2020 11/30/2022 3 JANSSEN ELEMENTARY SCHOOL, 420 WALLACE ST, COMBINED LOCKS, WI 54113 12/01/2020 11/30/2022 3 KAUKAUNA HIGH SCHOOL, 1701 COUNTY ROAD CE, KAUKAUNA, WI 54130 12/01/2020 11/30/2022 3 JR GERRITS MIDDLE SCHOOL, 545 SOUTH JOHN ST, KIMBERLY, WI 54136 12/01/2020 11/30/2022 3 KIMBERLY HIGH SCHOOL, 1662 E KENNEDY AVE, KIMBERLY, WI 54136 12/01/2020 11/30/2022 3 MAPLEVIEW INTERMEDIATE SCHOOL, 125 E KIMBERLY AVE, KIMBERLY, WI 54136 12/01/2020 11/30/2022 3 WESTSIDE ELEMENTARY SCHOOL, 746 W 3RD ST, KIMBERLY, WI 54136 12/01/2020 11/30/2022 3 LITTLE CHUTE HIGH SCHOOL, 1402 FREEDOM ROAD, LITTLE CHUTE, WI 54140 12/01/2020 11/30/2022 3 LITTLE CHUTE MIDDLE SCHOOL, 325 MEULMANS STREET, LITTLE CHUTE, WI 54140 12/01/2020 11/30/2022
09/28/2021 Page 214 of 222 Mental Health Program Directory By County, City, and Provider Name
THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY 1355
1478 KENWOOD DRIVE SUITE 1 TRACY SIEBERS Initial Cert: 03/01/1983 MENASHA, WI 54952 [email protected] Cert Eff: 03/01/2021 County: Winnebago Phone:(920) 886-9319 Cert Exp: 02/28/2023 Surveyor: Heather Lom Fax: (920) 886-9357
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2021 02/28/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2021 02/28/2023
Tier Branch Location(s) Branch Begin/End Dates 2 THE SAMARITAN COUNSELING CTR FOX VALLEY, 510 SULLIVAN AVENUE, KAUKAUNA, WI 54130 03/01/2021 02/28/2023 2 THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI 54961 03/01/2021 02/28/2023 2 THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI 54901 03/01/2021 02/28/2023
3 BRILLION ELEMENTARY & MIDDLE SCHOOL, 315 W MAIN ST, BRILLION, WI 54110 08/30/2021 02/28/2023 3 BRILLION HIGH SCHOOL, W1101 CTY RD HR, BRILLION, WI 54110 08/30/2021 02/28/2023 3 CHILTON ELEMENTARY & MIDDLE SCHOOL, 421 COURT ST, CHILTON, WI 53014 09/09/2021 02/28/2023 3 CHILTON HIGH SCOOL, 530 W MAIN ST, CHILTON, WI 53014 09/09/2021 02/28/2023 3 HILBERT ELEM, MIDDLE & HIGH SCHOOL, 1139 MILWAUKEE ST, HILBERT, WI 54129 08/25/2021 02/28/2023 3 NEW HOLSTEIN ELEMENTARY, 2226 PARK AVE, NEW HOLSTEIN, WI 53061 08/26/2021 02/28/2023 3 NEW HOLSTEIN MIDDLE & HIGH SCHOOL, 1715 PLYMOUTH ST, NEW HOLSTEIN, WI 53061 08/26/2021 02/28/2023 3 STOCKBRIDGE ELEM, MIDDLE & HIGH SCHOOL, 110 SCHOOL ST, STOCKBRIDGE, WI 53088 08/26/2021 02/28/2023
THEDACARE BEHAVIORAL HEALTH 2052
1095 MIDWAY ROAD JULIE MEYER Initial Cert: 07/31/1998 MENASHA, WI 54952 [email protected] Cert Eff: 10/01/2020 County: Winnebago Phone:(920) 720-3793 Cert Exp: 06/30/2022 Surveyor: Heather Lom Fax: (920) 720-3719
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2020 06/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 1 THEDACARE BEHAVIORAL HEALTH - PEABODY MANOR, 2600 S HERITAGE WOODS DR, APPLETON, 05/06/2021 06/30/2022 WI 54915 1 THEDACARE BEHAVIORAL HEALTH - JULIETTE MANOR, 482 OAK ST, BERLIN, WI 54923 06/23/2021 06/30/2022 1 THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI 54961 10/01/2020 06/30/2022 1 THEDACARE BEHAVIORAL HEALTH OSHKOSH CANCER CENTER, 491 S WASHBURN ST SUITE 100, 05/25/2021 06/30/2022 OSHKOSH, WI 54904 2 THEDACARE BEHAVIORAL HEALTH, 2500 E CAPITAL DRIVE, APPLETON, WI 54911 10/01/2020 06/30/2022 2 THEDACARE PHYSICIANS - BERLIN, 225 MEMORIAL DRIVE, BERLIN, WI 54923 10/01/2020 06/30/2022 2 THEDACARE BEHAVIORAL HEALTH, 333 GREEN BAY RD, NEENAH, WI 54956 10/01/2020 06/30/2022 2 THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI 54901 10/01/2020 06/30/2022 2 THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI 54166 10/01/2020 06/30/2022 2 THEDACARE BEHAVIORAL HEALTH, 902 RIVERSIDE DRIVE, #204, WAUPACA, WI 54981 10/01/2020 06/30/2022 2 THEDACARE PHYSICIANS - WEYAUWEGA, 206 S MILL ST, WEYAUWEGA, WI 54983 10/01/2020 06/30/2022
09/28/2021 Page 215 of 222 Mental Health Program Directory By County, City, and Provider Name
NEENAH REACH COUNSELING SERVICES 1830
1509 S COMMERCIAL STREET KRISTEN TRIMBERGER Initial Cert: 01/11/1993 NEENAH, WI 54956 [email protected] Cert Eff: 01/01/2021 County: Winnebago Phone:(920) 722-8150 Cert Exp: 12/31/2022 Surveyor: Heather Lom Fax: (920) 722-0142
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 REACH COUNSELING SERVICES, INC., 414 DOCTORS COURT, SUITE 110, OSHKOSH, WI 54901 01/01/2021 12/31/2022
THEDACARE REGIONAL MEDICAL CENTER NEENAH - BEHAVIORAL HEALTH 1946
130 SECOND STREET RONDA VETTER Initial Cert: 03/01/1983 NEENAH, WI 54956 [email protected] Cert Eff: 02/01/2021 County: Winnebago Phone:(920) 729-3100 Cert Exp: 01/31/2023 Surveyor: Heather Lom Fax: (920) 729-2906
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 02/01/2021 01/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES 2006
211 N COMMERCIAL STREET HEATHER FOUST Initial Cert: 07/01/1988 NEENAH, WI 54956 [email protected] Cert Eff: 11/01/2020 County: Winnebago Phone:(920) 729-2777 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 720-9682
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP 2278
211 N COMMERCIAL STREET HEATHER FOUST Initial Cert: 11/01/2000 NEENAH, WI 54956 [email protected] Cert Eff: 11/01/2020 County: Winnebago Phone:(920) 729-2789 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 729-2790
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
09/28/2021 Page 216 of 222 Mental Health Program Directory By County, City, and Provider Name
OSHKOSH ASCENSION NE WISCONSIN - MERCY CAMPUS 3218
500 S OAKWOOD RD MICHELLE MEENK Initial Cert: 06/01/2018 OSHKOSH, WI 54904 [email protected] Cert Eff: 09/01/2021 County: Winnebago Phone:(920) 223-3410 Cert Exp: 08/31/2023 Surveyor: Heather Lom Fax: (920) 223-3404
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2021 08/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2021 08/31/2023 NO BRANCH LOCATIONS
ASCENSION NE WISCONSIN - MERCY CAMPUS 3219
2700 W 9TH AVENUE STE 102 MICHELLE MEENK Initial Cert: 06/01/2018 OSHKOSH, WI 54904 [email protected] Cert Eff: 09/01/2019 County: Winnebago Phone:(920) 223-3410 Cert Exp: 08/31/2021 Surveyor: Heather Lom Fax: (920) 223-3404
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021 NO BRANCH LOCATIONS
AURORA MEDICAL GROUP OSHKOSH 2540
700 N WESTHAVEN DRIVE KATE WASSMANN Initial Cert: 09/01/2004 OSHKOSH, WI 54904 [email protected] Cert Eff: 09/01/2021 County: Winnebago Phone:(920) 456-2030 Cert Exp: 08/31/2023 Surveyor: Heather Lom Fax: (920) 456-2025
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2021 08/31/2023
Tier Branch Location(s) Branch Begin/End Dates 2 AURORA MEDICAL GROUP OSHKOSH, 210 WISCONSIN AMERICAN DRIVE, FOND DU LAC, WI 54935 09/01/2021 08/31/2023 2 AURORA MEDICAL GROUP OSHKOSH, 1136 WESTOWNE DR, NEENAH, WI 54956 09/01/2021 08/31/2023 2 AURORA MEDICAL GROUP NORTH FOND DU LAC, 700 N PARKRIDGE LN, NORTH FOND DU LAC, WI 09/01/2021 08/31/2023 54937 2 AURORA MEDICAL GROUP OSHKOSH, 855 N WESTHAVEN DR, OSHKOSH, WI 54904 09/01/2021 08/31/2023 2 AURORA MEDICAL GROUP OSHKOSH, 1242 W FOND DU LAC STREET, RIPON, WI 54971 09/01/2021 08/31/2023
AURORA MEDICAL GROUP OSHKOSH - DOCTORS COURT 3282
414 DOCTORS COURT KATE WASSMANN Initial Cert: 02/18/2020 OSHKOSH, WI 54901 [email protected] Cert Eff: 02/01/2021 County: Winnebago Phone:(920) 303-5100 Cert Exp: 01/31/2023 Surveyor: Heather Lom Fax: (920) 303-5151
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 02/01/2021 01/31/2023 CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2021 01/31/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2021 01/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 217 of 222 Mental Health Program Directory By County, City, and Provider Name
OSHKOSH COUNSELING CENTER, INC. 1723
501 MERRITT AVENUE KATIE NIEMUTH Initial Cert: 09/01/1985 OSHKOSH, WI 54901 [email protected] Cert Eff: 12/01/2019 County: Winnebago Phone:(920) 231-2858 Cert Exp: 11/30/2021 Surveyor: Heather Lom Fax: (920) 231-4048
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021 NO BRANCH LOCATIONS
WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES 2007
220 WASHINGTON AVENUE HEATHER FOUST Initial Cert: 10/01/1975 OSHKOSH, WI 54903 [email protected] Cert Eff: 11/01/2020 County: Winnebago Phone:(920) 236-4700 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 236-1157 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2020 10/31/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2020 10/31/2022 CSAS-PREVENTION DHS 75.04 11/01/2020 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP 2266
220 WASHINGTON AVENUE HEATHER FOUST Initial Cert: 10/01/1975 OSHKOSH, WI 54903 [email protected] Cert Eff: 11/01/2020 County: Winnebago Phone:(920) 236-4700 Cert Exp: 10/31/2022 Surveyor: Heather Lom Fax: (920) 236-1157
Services Adm Code Service Begin/End Dates MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2020 10/31/2022 NO BRANCH LOCATIONS
WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES 2579
220 WASHINGTON AVENUE HEATHER FOUST Initial Cert: 03/09/2005 OSHKOSH, WI 54903 [email protected] Cert Eff: 04/01/2021 County: Winnebago Phone:(920) 236-4700 Cert Exp: 03/31/2023 Surveyor: Heather Lom Fax: (920) 236-1157
CCS Affiliaton:NORTHEASTERN REGION CCS CONSORTIUM V3 Begin: 01/01/2020
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 218 of 222 Mental Health Program Directory By County, City, and Provider Name
ROSCOE HOPE - CHILD AND FAMILY COUNSELING INC 3182
11447 2ND ST SUITE 9B JAMIE WAGNER Initial Cert: 08/22/2017 ROSCOE, IL 61073 [email protected] Cert Eff: 08/01/2020 County: Winnebago Phone:(815) 601-4673 Cert Exp: 07/31/2022 Surveyor: Anastasia E. Vega Fax: (866) 303-8062
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2020 07/31/2022
Tier Branch Location(s) Branch Begin/End Dates 2 HOPE - CHILD AND FAMILY COUNSELING, INC, 501 N RIVERSIDE DR STE 110, GURNEE, IL 60031 11/05/2020 07/31/2022 2 HOPE - CHILD AND FAMILY COUNSELING, 2000 E RACINE ST, STE 100, JANESVILLE, WI 53546 08/01/2020 07/31/2022
Non-Certified School Setting(s) Setting Begin/End Dates BELOIT LEARNING ACADEMY, 1033 WOODWARD AVE, BELOIT, WI 53511 08/01/2020 07/31/2022 BELOIT MEMORIAL HIGH SCHOOL, 1225 FOURTH STREET, BELOIT, WI 53511 08/01/2020 07/31/2022 FRUZEN INTERMEDIATE, 2600 MILWAUEE RD, BELOIT, WI 53511 08/01/2020 07/31/2022 MCNEEL, 1524 FREDERICK ST, BELOIT, WI 53511 08/01/2020 07/31/2022 TODD ELEMENTARY, 1621 OAKWOOD AVE, BELOIT, WI 53511 08/01/2020 07/31/2022 CRAIG HIGH SCHOOL, 401 S RANDALL AVE, JANESVILLE, WI 53545 08/01/2020 07/31/2022 FRANKLIN MIDDLE SCHOOL, 450 N CROSBY AVE, JANESVILLE, WI 53548 08/01/2020 07/31/2022 JACKSON ELEMENTARY, 441 W BURBANK AVE, JANESVILLE, WI 53545 08/01/2020 07/31/2022 LINCOLN ELEMENTARY, 1821 CONDE ST, JANESVILLE, WI 53546 08/01/2020 07/31/2022 MADISON ELEMENTARY SCHOOL, 331 N GRANT AVE, JANESVILLE, WI 53548 08/01/2020 07/31/2022 PARKER HIGH SCHOOL, 3125 MINERAL POINT AVE, JANESVILLE, WI 53548 08/01/2020 07/31/2022 TAGOS LEADERSHIP ACADEMY, 1350 N PARKER DR, JANESVILLE, WI 53545 08/01/2020 07/31/2022 WILSON ELEMENTARY, 465 ROCKPORT RD, JANESVILLE, WI 53548 08/01/2020 07/31/2022
WINNEBAGO WINNEBAGO MENTAL HEALTH INSTITUTE 2008
TREFFERT DRIVE & BUTLER AVENUE JESSICA ANDREWS Initial Cert: 10/01/1975 WINNEBAGO, WI 54985 [email protected] Cert Eff: 11/01/2019 County: Winnebago Phone:(920) 237-2802 Cert Exp: 10/31/2021 Surveyor: Heather Lom Fax: (920) 237-2043
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 11/01/2019 10/31/2021 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/01/2019 10/31/2021 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021 NO BRANCH LOCATIONS
09/28/2021 Page 219 of 222 Mental Health Program Directory By County, City, and Provider Name
WOOD MARSHFIELD MARRIAGE AND FAMILY HEALTH SERVICES, LTD. 2623
501 SOUTH CHERRY AVE, #5 VICTOR MICHALEK Initial Cert: 01/01/2006 MARSHFIELD, WI 54449 [email protected] Cert Eff: 01/01/2021 County: Wood Phone:(715) 486-8302 Cert Exp: 12/31/2022 Surveyor: Roderick Senn Fax: (715) 832-0771
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 01/01/2021 12/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2021 12/31/2022
Tier Branch Location(s) Branch Begin/End Dates 3 GRANT ELEMENTARY, 425 W UPHAM ST, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 LINCOLN ELEMENTARY, 1621 S FELKER AVE, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 MADISON ELEMENTARY, 510 N PALMETTO AVE, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 MARSHFIELD HIGH SCHOOL, 1401 E BECKER ROAD, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 MARSHFIELD MIDDLE SCHOOL, 900 EAST 4TH STREET, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 NASONVILLE ELEMENTARY, 11044 US HIGHWAY 10, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 WASHINGTON ELEMENTARY, 1112 W 11TH ST, MARSHFIELD, WI 54449 01/01/2021 12/31/2022 3 LINCOLN HIGH SCHOOL, 1801 16TH STREET SOUTH, WISCONSIN RAPIDS, WI 54494 01/01/2021 12/31/2022
MARSHFIELD MEDICAL CENTER CLINIC PROF SERVICES 1566
1000 N OAK AVENUE SANDRA BUMP Initial Cert: 12/01/1982 MARSHFIELD, WI 54449 [email protected] Cert Eff: 11/01/2020 County: Wood Phone:(715) 387-5744 Cert Exp: 10/31/2022 Surveyor: Roderick Senn Fax: (715) 387-9025
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 01/04/2021 10/31/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2020 10/31/2022
Tier Branch Location(s) Branch Begin/End Dates 1 MARSHFIELD CLINIC-CHIPPEWA FALLS, 2655 CO HWY I, CHIPPEWA FALLS, WI 54729 11/01/2020 10/31/2022 1 MARSHFIELD CLINIC-LADYSMITH, 906 COLLEGE AVE, LADYSMITH, WI 54848 11/01/2020 10/31/2022 1 MARSHFIELD CLINIC-MOSINEE CENTER, 390 ORBITING DR, MOSINEE, WI 54455 11/01/2020 10/31/2022 1 MARSHFIELD CLINIC-WAUSAU CENTER, 2727 PLAZA DR, WAUSAU, WI 54401 11/01/2020 10/31/2022 1 MARSHFIELD CLINIC-WI RAPIDS CENTER, 220 24TH ST, WISCONSIN RAPIDS, WI 54494 11/01/2020 10/31/2022
2 MARSHFIELD CLINIC - BEAVER DAM, 707 S. UNIVERSTIY AVE. SUITE 360, BEAVER DAM, WI 53916 11/05/2020 10/31/2022 2 MARSHFIELD CLINIC-LAKE HALLIE, 12961 27TH AVE, CHIPPEWA FALLS, WI 54729 11/01/2020 10/31/2022 2 MARSHFIELD CLINIC-RIVERVIEW, 1000 STARR AVE, EAU CLAIRE, WI 54701 11/01/2020 10/31/2022 2 MARSHFIELD CLINIC-MINOCQUA CENTER, 9601 TOWNLINE RD, MINOCQUA, WI 54548 11/01/2020 10/31/2022 2 MARSHFIELD CLINIC-PARK FALLS CENTER, 50 SHERRY AVE, PARK FALLS, WI 54552 11/01/2020 10/31/2022 2 MARSHFIELD CLINIC - PLOVER COUNSELING CENTER, 2450 VINEYARD DR, PLOVER, WI 54467 01/04/2021 10/31/2022 2 MARSHFIELD CLINIC-LAKEWOODS, 1215 W KNAPP, RICE LAKE, WI 54868 11/01/2020 10/31/2022
09/28/2021 Page 220 of 222 Mental Health Program Directory By County, City, and Provider Name
NORWOOD HEALTH CENTER 1709
1600 N CHESTNUT AVE JORDON BRUCE Initial Cert: 04/01/1980 MARSHFIELD, WI 54449 [email protected] Cert Eff: 02/01/2021 County: Wood Phone:(715) 384-2188 Cert Exp: 01/31/2023 Surveyor: Roderick Senn Fax: (715) 387-1533
Services Adm Code Service Begin/End Dates CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 02/01/2021 01/31/2023 MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2021 01/31/2023 NO BRANCH LOCATIONS WISCONSIN RAPIDS ASPIRUS RIVERVIEW BEHAVIORAL HEALTH CLINIC 3231
420 DEWEY ST JULIE MANCL Initial Cert: 10/01/2018 WISCONSIN RAPIDS, WI 54494 [email protected] Cert Eff: 04/01/2021 County: Wood Phone:(715) 422-9319 Cert Exp: 09/30/2022 Surveyor: Roderick Senn Fax: (715) 422-9320
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2021 09/30/2022 NO BRANCH LOCATIONS
CENTRAL WISCONSIN COUNSELING ASSOCIATES 2293
320 W. GRAND AVE SUITE 304A AMY GUNDERSON Initial Cert: 01/01/2001 WISCONSIN RAPIDS, WI 54495 [email protected] Cert Eff: 01/01/2020 County: Wood Phone:(715) 424-6960 Cert Exp: 12/31/2021 Surveyor: Roderick Senn Fax: (715) 424-6963
Services Adm Code Service Begin/End Dates MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021
Tier Branch Location(s) Branch Begin/End Dates 3 LINCOLN HIGH SCHOOL, 1801 - 16TH STREET SOUTH, WISCONSIN RAPIDS, WI 54494 01/01/2020 12/31/2021 3 RIVER CITIES HIGH SCHOOL, 2390 - 48TH STREET SOUTH, WISCONSIN RAPIDS, WI 54495 01/01/2020 12/31/2021
CLINICAL SERVICES 3268
420 3RD STREET SO JULIE SIGLER EDMUNDSON Initial Cert: 09/18/2019 WISCONSIN RAPIDS, WI 54494 [email protected] Cert Eff: 10/01/2021 County: Wood Phone:(715) 712-1370 Cert Exp: 09/30/2023 Surveyor: Roderick Senn Fax: (715) 712-1341
Services Adm Code Service Begin/End Dates CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2021 09/30/2023 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2021 09/30/2023 NO BRANCH LOCATIONS
NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - WISCONSIN RAPIDS 2291
110 24TH ST S JACKIE MAURER Initial Cert: 02/12/2001 WISCONSIN RAPIDS, WI 54494 [email protected] Cert Eff: 04/01/2021 County: Wood Phone:(715) 424-5040 Cert Exp: 03/31/2023 Surveyor: Roderick Senn Fax: (855) 897-2741
Services Adm Code Service Begin/End Dates MENTAL HEALTH DAY TREATMENT FOR YOUTH COMMUNITY BASED DHS 40.03(10) 04/01/2021 03/31/2023 NO BRANCH LOCATIONS
09/28/2021 Page 221 of 222 Mental Health Program Directory By County, City, and Provider Name
WOOD COUNTY HUMAN SERVICES CCS 2678
111 W JACKSON ST NICOLE HEISER Initial Cert: 08/01/1977 WISCONSIN RAPIDS, WI 54494 [email protected] Cert Eff: 10/01/2020 County: Wood Phone:(715) 421-8800 Cert Exp: 06/30/2022 Surveyor: Roderick Senn Fax: (715) 421-2266
CCS Affiliaton:PORTAGE WOOD PARTNERSHIP Begin: 09/01/2014
Services Adm Code Service Begin/End Dates CCS REGIONAL MODEL SHARED SERVICES DHS 36 10/01/2020 06/30/2022 NO BRANCH LOCATIONS
WOOD COUNTY HUMAN SERVICES DEPARTMENT 2019
111 W JACKSON ST STEPHANIE GUDMUNSEN Initial Cert: 08/01/1977 WISCONSIN RAPIDS, WI 54494 [email protected] Cert Eff: 10/01/2020 County: Wood Phone:(715) 421-8849 Cert Exp: 06/30/2022 Surveyor: Roderick Senn Fax: (715) 421-2266 Crisis Intervention Services Regional Designation Begin End Lead BEHAVIORAL HEALTH TRAINING PARTNERSHIP 01/01/2020 BRIDGEWAY ADULT CRISIS STABILIZATION CBRF 01/01/2020 COLLABORATIVE CRISIS INTERVENTION SERVICES TO YOUTH 01/01/2020
Services Adm Code Service Begin/End Dates CSAS-DAY TREATMENT DHS 75.12 10/01/2020 06/30/2022 CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2020 06/30/2022 CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2020 06/30/2022 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2020 06/30/2022 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2020 06/30/2022
Tier Branch Location(s) Branch Begin/End Dates 2 CORNERSTONE, 630 S CENTRAL AVE SUITE 204, MARSHFIELD, WI 54449 10/01/2020 06/30/2022 2 NORWOOD HEALTH CARE BRANCH OFFICE, 1600 NORTH CHESTNUT, MARSHFIELD, WI 54449 10/01/2020 06/30/2022
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