Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By...

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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance STATE OF WISCONSIN 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 3243 ADAMS COUNTY HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Surveyor: Tina Dary Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 01/31/2022 02/01/2020 01/17/2019 (608) 339-4593 (608) 339-4505 [email protected] KAY SAARINEN-BARR County: Adams FRIENDSHIP, WI 53934 108 E NORTH ST Service Begin / End Dates Adm Code MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2020 01/31/2022 Services NO BRANCH LOCATIONS 2810 ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Surveyor: Tina Dary Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 02/28/2021 03/01/2019 12/10/2008 (608) 339-4585 (608) 339-4505 [email protected] KAY SAARINEN-BARR County: Adams FRIENDSHIP, WI 53934 108 E NORTH STREET CCS Affiliaton: 09/01/2014 12/31/2015 Begin: End: Lead: Central Wisconsin Health Partnership Service Begin / End Dates Adm Code CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 03/01/2019 11/29/2019 Services NO BRANCH LOCATIONS 1253 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Surveyor: Tina Dary Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 02/29/2020 03/01/2018 09/01/1990 (608) 339-4585 (608) 339-4505 [email protected] REBECCA BURRESS County: Adams FRIENDSHIP, WI 53934 108 E NORTH STREET Service Begin / End Dates Adm Code CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020 CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 11/29/2019 MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 11/29/2019 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020 Services Setting Begin / End Dates Non - Certified School Setting ( s ) 03/01/2018 02/29/2020 ADAMS/FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910 03/01/2018 02/29/2020 ADAMS/FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910 2/11/2020 Page 1 of 224

Transcript of Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By...

Page 1: Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By County, City, and Provider Name FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH

DEPARTMENT OF HEALTH SERVICESDivision of Quality Assurance

STATE OF WISCONSINBureau of Health Services

PO Box 2969Madison, WI 53701-2969

Community Mental HealthProgram Certification DirectoryBy County, City, and Provider Name

ADAMSFRIENDSHIP

3243ADAMS COUNTY HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202202/01/202001/17/2019

(608) 339-4593

(608) [email protected] SAARINEN-BARR

County: AdamsFRIENDSHIP, WI 53934108 E NORTH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2020 01/31/2022

Services

NO BRANCH LOCATIONS

2810ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201912/10/2008

(608) 339-4585

(608) [email protected] SAARINEN-BARR

County: AdamsFRIENDSHIP, WI 53934108 E NORTH STREET

CCS Affiliaton: 09/01/2014 12/31/2015Begin: End: Lead:Central Wisconsin Health Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 03/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

1253ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/01/1990

(608) 339-4585

(608) [email protected] BURRESS

County: AdamsFRIENDSHIP, WI 53934108 E NORTH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020

Services

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2018 02/29/2020ADAMS/FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 53910

03/01/2018 02/29/2020ADAMS/FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 53910

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Page 2: Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By County, City, and Provider Name FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH

Mental Health Program Directory By County, City, and Provider Name

3245FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH & RECOVERY CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202003/14/201903/14/2019

() -

(608) [email protected] ROBINSON

County: AdamsFRIENDSHIP, WI 53934302 W LAKE ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/14/2019 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/14/2019 03/31/2020

Services

NO BRANCH LOCATIONS

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Page 3: Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By County, City, and Provider Name FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH

Mental Health Program Directory By County, City, and Provider Name

ASHLANDASHLAND

3055ASHLAND COUNTY CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202005/01/201901/01/2015

() -

(715) [email protected] BARNINGHAM

County: AshlandASHLAND, WI 54806514 WEST MAIN STREET

CCS Affiliaton: 01/01/2015 04/30/2019Begin: End: Lead:New Horizons North CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 05/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

3258ASHLAND COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/31/201905/31/2019

(715) 682-7176

(715) [email protected] LEVNO

County: AshlandASHLAND, WI 54806514 MAIN STREET WEST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/31/2019 04/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 05/31/2019

11/29/2019

Services

NO BRANCH LOCATIONS

2639ASHLAND COUNTY HEALTH AND HUMAN SERVICES/NORTHLAND COUNSELING SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201901/26/2006

(715) 682-2148

(715) [email protected] LUND

County: AshlandASHLAND, WI 548061619 WEST THIRD STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2019 03/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 04/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2154BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/1999

(715) 685-5102

(715) [email protected] JENSEN

County: AshlandASHLAND, WI 548061635 MAPLE LANE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 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

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2019 09/30/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2019 09/30/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

10/01/2019 11/29/2019

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021NORTHLAND COLLEGE, 1411 ELLIS AVE, ASHLAND, WI 548061

10/01/2019 09/30/2021ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 548063

10/01/2019 09/30/2021DRUMMOND AREA SCHOOL DISTRICT, 52440 EASTERN AVE, DRUMMOND, WI 548323

10/01/2019 09/30/2021HURLEY SCHOOL DISTRICT, 5503 W RANGE VIEW DR, HURLEY, WI 545343

10/01/2019 09/30/2021LAKE SUPERIOR PRIMARY SCHOOL, 1101 BINSFIELD ROAD, ASHLAND, WI 548063

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Mental Health Program Directory By County, City, and Provider Name

BARRONBARRON

2640BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201901/01/2006

(715) 537-6848

(715) [email protected] HAY

County: BarronBARRON, WI 54812335 EAST MONROE AVE ROOM 338

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

3230BARRON COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2019

(715) 537-6848

(715) [email protected] HAY

County: BarronBARRON, WI 54812335 E MONROE AVE

CCS Affiliaton: 01/01/2019Begin: End: Lead:BESt CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

CUMBERLAND

3148CUMBERLAND MEMORIAL HOSPITAL INC DBA CUMBERLAND HEALTHCARE

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/06/2016

(715) 822-7221

(715) [email protected] ADER

County: BarronCUMBERLAND, WI 548291110 7TH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021CUMBERLAND HEALTHCARE - TURTLE LAKE, 632 US HWY 8, TURTLE LAKE, WI 548891

Setting Begin/End DatesNon-Certified School Setting(s)10/01/2019 09/30/2021CUMBERLAND ELEMENTARY SCHOOL, 1530 2ND AVE, CUMBERLAND, WI 54829

RICE LAKE

2925BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/30/202111/01/201911/01/2010

(715) 537-6848

(715) [email protected] HAY

County: BarronRICE LAKE, WI 54868935 N MAIN ST, LOWER LEVEL

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2707MARRIAGE AND FAMILY HEALTH SERVICES, LTD

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/01/2007

(715) 832-0771

(715) [email protected] SCHULZ-JOHNSTON

County: BarronRICE LAKE, WI 54868105 WEST AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

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Page 7: Wisconsin Community Mental Health Program Certification ... · Mental Health Program Directory By County, City, and Provider Name FAMILY HEALTH LA CLINICA ROCHE-A-CRI BEHAVIORAL HEALTH

Mental Health Program Directory By County, City, and Provider Name

BAYFIELDBAYFIELD

3157RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202004/01/2017

(715) 779-3782

(715) [email protected] GURNOE

County: BayfieldBAYFIELD, WI 5481437390 NORTH BRADUM ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

3143RED CLIFF COMMUNITY HEALTH CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201905/20/2016

(715) 779-3362

(715) [email protected] GURNOE

County: BayfieldBAYFIELD, WI 5481436745 AIKEN ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2019 03/31/2021MISHOMIS WELLNESS CENTER, 37390 N BRADUM ROAD, BAYFIELD, WI 548142

04/01/2019 03/31/2021RCCHC WASHBURN, 409 W BAYFIELD ST, WASHBURN, WI 548912

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2019 03/31/2021BAYFIELD SCHOOL DISTRICT, 300 N 4TH ST, BAYFIELD, WI 54814

04/01/2019 03/31/2021RED CLIFF EARLY CHILDHOOD CENTER, 89830 TINY TOT DR, BAYFIELD, WI 54814

04/01/2019 03/31/2021WASHBURN ELEMENTARY SCHOOL, 411 W 8TH ST, WASHBURN, WI 54891

04/01/2019 03/31/2021WASHBURN HIGH/MIDDLE SCHOOL, 305 W 4TH ST, WASHBURN, WI 54891

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Mental Health Program Directory By County, City, and Provider Name

IRON RIVER

1064NORTHLAKES COMMUNITY CLINIC AODA SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/1984

(715) 372-5067

(715) [email protected] AKL

County: BayfieldIRON RIVER, WI 548477665 US HWY 2

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/08/2019 08/31/2020NORTHLAKES COMMUNITY CLINIC-HURLEY, 210 5TH AVE N, HURLEY, WI 545341

09/01/2018 08/31/2020NORTHLAKES CLINIC - HAYWARD RIVERS EDGE, 15954 RIVERS EDGE DR, #121, HAYWARD, WI 54843

2

09/01/2018 08/31/2020NORTHLAKES COMMUNITY CLINIC - DOWNTOWN, 300 MAIN STREET WEST, ASHLAND, WI 548062

12/27/2018 08/31/2020NORTHLAKES COMMUNITY CLINIC - LAKEWOOD, 15397 HIGHWAY 32, LAKEWOOD, WI 541382

11/01/2018 08/31/2020NORTHLAKES COMMUNITY CLINIC - TURTLE LAKE, 730 SWEDE AVE, TURTLE LAKE, WI 548892

09/01/2018 08/31/2020NORTHLAKES COMMUNITY CLINIC - WASHBURN, 101 THOMPSON ROAD, WASHBURN, WI 548912

09/01/2018 08/31/2020NORTHLAKES COMMUNITY CLINIC-MINONG MEDICAL CLINIC, 600 SHELL CREEK ROAD, MINONG, WI 54859

2

11/26/2019 08/31/2020NORTHLAKES COMMUNITY CLINIC-WHITE LAKE, 524 BISSEL ST, WHITE LAKE, WI 544912

01/06/2020 08/31/2020ALMENA ELEMENTARY SCHOOL, 230 LULU AVE, ALMENA, WI 548053

09/01/2018 08/31/2020ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI 548063

09/01/2018 08/31/2020ASHLAND MIDDLE SCHOOL, 203 - 11TH STREET EAST, ASHLAND, WI 548063

12/03/2019 08/31/2020BARRON HIGH SCHOOL, 1050 E WODDLAND AVE, BARRON, WI 548123

12/12/2019 08/31/2020CAMERON ELEMENTARY SCHOOL, 919 N 2ND ST, CAMERON, WI 548223

12/12/2019 08/31/2020CAMERON HIGH SCHOOL, 600 WISCONSIN AVE, CAMERON, WI 548223

12/12/2019 08/31/2020CAMERON MIDDLE SCHOOL, 600 WISCONSIN AVE, CAMERON, WI 548223

09/01/2018 08/31/2020CLAYTON SCHOOL, 236 POLK AVENUE WEST, CLAYTON, WI 540043

09/01/2018 08/31/2020CLEAR LAKE JR/SR HIGH SCHOOL, 1101 THIRD ST SW, CLEAR LAKE, WI 540053

12/13/2019 08/31/2020HURLEY SCHOOLS K-12, 5503 W RANGEVIEW DR, HURLEY, WI 545343

09/01/2018 08/31/2020LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI 54806

3

09/01/2018 08/31/2020PRAIRIE FARM SCHOOL, 630 RIVER AVE S, PRAIRIE FARM, WI 547623

01/06/2020 08/31/2020RIDGELAND ELEMENTARY SCHOOL, 315 MAIN ST, RIDGELAND, WI 547633

12/03/2019 08/31/2020RIVERVIEW MIDDLE SCHOOL, 135 W RIVER AVE, BARRON, WI 548123

12/27/2018 08/31/2020SURING PUBLIC SCHOOLS K-12, 411 E ALGOMA ST, SURING, WI 541743

09/01/2018 08/31/2020TURTLE LAKE SCHOOL DISTRICT, 205 OAK STREET NORTH, TURTLE LAKE, WI 548893

06/25/2019 08/31/2020WABENO ELEMENTARY SCHOOL, 4346 MILL LN, WABENO, WI 545663

09/01/2018 08/31/2020WASHBURN ELEMENTARY SCHOOL/ELC, 411 W 8TH STREET, WASHBURN, WI 548913

09/01/2018 08/31/2020WASHBURN MIDDLE/HIGH SCHOOL, 305 4TH AVENUE WEST, WASHBURN, WI 548913

11/26/2019 08/31/2020WHITE LAKE K-12, 405 BISSELL ST, WHITE LAKE, WI 544913

09/01/2018 08/31/2020WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVE, BARRON, WI 548123

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Mental Health Program Directory By County, City, and Provider Name

WASHBURN

3054BAYFIELD COUNTY CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202005/01/201901/01/2015

(715) 373-6130

(715) [email protected] SKULAN

County: BayfieldWASHBURN, WI 54891117 EAST FIFTH STREET

CCS Affiliaton: 01/01/2015 04/30/2019Begin: End: Lead:New Horizons North CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 05/01/2019 12/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 05/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

3253NORTHLAND COMMUNITY SERVICES BAYFIELD

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/18/201903/18/2019

(715) 373-0162

(715) [email protected] LUND

County: BayfieldWASHBURN, WI 5489121 W OMAHA ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/18/2019 02/29/2020

Services

NO BRANCH LOCATIONS

2361NORTHLAND COUNSELING SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2001

(715) 373-0162

(715) [email protected] LUND

County: BayfieldWASHBURN, WI 5489121 W OMAHA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020NORTHLAND COUNSELING SERVICES - ASHLAND, 1613 WEST THIRD STREET, ASHLAND, WI 548061

07/01/2018 06/30/2020NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI 548911

07/01/2018 06/30/2020NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI 545211

07/01/2018 06/30/2020NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI 548062

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Mental Health Program Directory By County, City, and Provider Name

BROWNDE PERE

2736AURORA BEHAVIORAL HEALTH CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/08/2007

(920) 403-8209

(920) [email protected] ROLLIN

County: BrownDE PERE, WI 541151881 CHICAGO STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020AURORA HEALTH CARE - GREEN BAY, 1160 KEPLER DR, GREEN BAY, WI 543112

07/01/2018 06/30/2020AURORA MEDICAL GROUP MARINETTE, 4061 OLD PESHTIGO RD, MARINETTE, WI 541432

1301EMPLOYEE RESOURCE CENTER INC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201807/01/1989

(920) 403-7360

(920) [email protected] PECARD

County: BrownDE PERE, WI 541151511 WEST MAIN AVE SUITE 100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

2597LIVING HOPE CHRISTIAN COUNSELING

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201808/12/2005

(920) 336-3181

(920) [email protected] C JOHNSON

County: BrownDE PERE, WI 541152066 LAWRENCE DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2924NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST DIRECTIONS - DE PERE

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201907/26/2010

(833) 581-5765

(920) [email protected] MAURER

County: BrownDE PERE, WI 54115300 S 6TH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021NORHTWEST DIRECTIONS-STEVENS POINT, 525 - 4TH AVENUE, STEVENS POINT, WI 544811

02/01/2019 01/31/2021NORTHWEST DIRECTIONS - MENOMONIE, 402 TECHNOLOGY DR E, MENOMONIE, WI 547511

02/01/2019 01/31/2021NORTHWEST DIRECTIONS - RHINELANDER, 915 ACACIA LN, RHINELANDER, WI 545011

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-AMERY, PO BOX 167, 1096 APPLE AVENUE, AMERY, WI 540011

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-BLACK RIVER FALLS, N6643 COUNTY ROAD A, BLACK RIVER FALLS, WI 54615

1

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-GREEN BAY, 123 SOUTH VAN BUREN STREET, GREEN BAY, WI 543011

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-HAYWARD, 10692 U.S. HIGHWAY 63, HAYWARD, WI 548431

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-NORTHERN LIGHTS, 1201 NORTH 28TH STREET, SUPERIOR, WI 548801

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-SIREN, 7670 JOHNSON STREET, SIREN, WI 548721

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-WAUSAU, 5655 N 28TH AVENUE, WAUSAU, WI 544011

02/01/2019 01/31/2021NORTHWEST DIRECTIONS-WISCONSIN RAPIDS, 110-24TH STREET SOUTH, WISCONSIN RAPIDS, WI 54494

1

Setting Begin/End DatesNon-Certified School Setting(s)02/01/2019 01/31/2021COLFAX MIDDLE/HIGH SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730

02/01/2019 01/31/2021GREAT LAKES ELEMENTARY SCHOOL, 129 N 28TH ST, SUPERIOR, WI 54880

02/01/2019 01/31/2021MENOMONIE HIGH SCHOOL, 1715 5TH ST W, MENOMONIE, WI 54751

02/01/2019 01/31/2021MENOMONIE MIDDLE SCHOOL, 920 21ST ST E, MENOMONIE, WI 54751

02/01/2019 01/31/2021NORTHERN LIGHTS ELEMENTARY SCHOOL, 1201 N 28TH ST, SUPERIOR, WI 54880

2160NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - DE PERE

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/1999

(833) 581-5765

(920) [email protected] JOHNSON

County: BrownDE PERE, WI 54115300 S SIXTH ST, LOWER LEVEL

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 11/01/2019 10/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

11/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1743ST. VINCENT HOSPITAL DBA PREVEA HEALTH

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201812/09/1996

(920) 272-1201

(920) [email protected] TUTSKEY

County: BrownDE PERE, WI 541153860 MONROE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019HSHS ST VINCENT HOSPITAL, 835 S VAN BUREN ST, GREEN BAY, WI 543011

01/01/2018 12/31/2019PREVEA ALLOUEZ HEALTH CENTER, 1821 WEBSTER AVE, GREEN BAY, WI 543011

01/01/2018 12/31/2019PREVEA EAST MASON HEALTH CENTER, 3021 VOYAGER DRIVE, GREEN BAY, WI 543111

01/01/2018 12/31/2019PREVEA LUXEMBURG HEALTH CENTER, 101 SCHOOL CREEK TRAIL, LUXEMBURG, WI 542171

01/01/2018 12/31/2019PREVEA OCONTO HEALTH CENTER, 620 SMITH STREET, OCONTO, WI 541531

01/01/2018 12/31/2019PREVEA PULASKI HEALTH CENTER, 940 S AUGUSTINE STREET, PULASKI, WI 541621

01/01/2018 12/31/2019PREVEA SHAWANO AVENUE HEALTH, 1727 SHAWANO AVENUE, GREEN BAY, WI 543031

07/16/2018 12/31/2019PREVEA SHAWANO HEALTH CENTER, 1300 E GREEN BAY ST, SHAWANO, WI 541661

01/01/2018 12/31/2019PREVEA HOWARD HEALTH CENTER, 2793 LINEVILLE RD, GREEN BAY, WI 543132

05/29/2018 12/31/2019PREVEA MARINETTE HEALTH CENTER, 1409 CLEVELAND AVE, MARINETTE, WI 541432

05/29/2018 12/31/2019PREVEA OCONTO FALLS HEALTH CENTER, 835 S MAIN ST, OCONTO, WI 541532

01/01/2018 12/31/2019PREVEA ST MARY'S HEALTH CENTER, 1715 DOUSMAN ST, GREEN BAY, WI 543032

01/01/2018 12/31/2019PREVEA WEST DEPERE HEALTH CENTER, 1686 EISENHOWER RD, DE PERE, WI 541152

01/01/2018 12/31/2019FOREST GLEN, 1935 CARDINAL LN, GREEN BAY, WI 543133

11/12/2018 12/31/2019FRANKLIN MIDDLE SCHOOL, 1233 LORE LN, GREEN BAY, WI 543033

01/01/2018 12/31/2019MEADOWBROOK ELEMENTARY, 720 HILLCREST HEIGHTS, GREEN BAY, WI 543133

01/01/2018 12/31/2019PULASKI HIGH SCHOOL, 1040 S SAINT AUGUSTINE ST, PULASKI, WI 541623

2460WISCONSIN EARLY AUTISM PROJECT, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2003

(920) 338-1616

(920) [email protected] HOOPS

County: BrownDE PERE, WI 541151141 W MAIN AVE #201

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

GREEN BAY

3047BAETEN COUNSELING & CONSULTATION TEAM, SC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/06/2014

(920) 632-4315

(920) [email protected] BAETEN

County: BrownGREEN BAY, WI 543012920 S WEBSTER AVE, SUITE B

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/26/2019 07/31/2021DENMARK HIGH SCHOOL, 450 N WALL ST, DENMARK, WI 542083

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Mental Health Program Directory By County, City, and Provider Name

1098BELLIN PSYCHIATRIC CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/1984

(920) 431-0333

(920) [email protected] COUNARD

County: BrownGREEN BAY, WI 54301301 E ST JOSEPH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/2018 03/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 11/29/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 04/01/2018 03/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI 543011

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - ALGOMA, 831 PARKER ST, ALGOMA, WI 542011

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - BONDUEL, 401 W MILL ST, BONDUEL, WI 541071

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - BRILLION, 964 W RYAN ST, STE B, BRILLION, WI 541101

11/01/2019 03/31/2020BELLIN PSYCHIATRIC CTR - GREEN BAY, 704 S WEBSTER AVE, 3RD FL, STE 110, GREEN BAY, WI 54301

1

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - KEWAUNEE, 575 - 4TH ST, KEWAUNEE, WI 542161

04/01/2018 03/31/2020BELLIN HEALTH GENERATIONS, 720 S VAN BUREN ST #101, GREEN BAY, WI 543012

04/01/2018 03/31/2020BELLIN HEALTH RIVERSIDE PSYCHIATRIC GROUP, 1325 ANGELS PATH, DE PERE, WI 541152

11/01/2018 03/31/2020BELLIN HEALTH SURING, 307 MANOR DRIVE, SURING, WI 541742

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI 541152

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - OCONTO FALLS, 107 E HIGHLAND DR, OCONTO FALLS, WI 541542

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR - STURGEON BAY, 311 N 3RD AVENUE, STURGEON BAY, WI 542352

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR-NEURO TEAM, 725 S WEBSTER, GREEN BAY, WI 543052

04/01/2018 03/31/2020BELLIN PSYCHIATRIC CTR-W DE PERE, 1800 LAWRENCE DR, DE PERE, WI 541152

04/01/2018 03/31/2020ALGOMA ELEMENTARY SCHOOL, 514 FREEMONT STREET, ALGOMA, WI 542013

04/01/2018 03/31/2020ALGOMA MIDDLE AND HIGH SCHOOL, 1715 DIVISION STREET, ALGOMA, WI 542013

09/01/2018 03/31/2020DANZ ELEMENTARY SCHOOL, 2130 BASTEN STREET, GREEN BAY, WI 543023

09/01/2018 03/31/2020DE PERE MIDDLE SCHOOL, 700 SWAN ROAD, DE PERE, WI 541153

04/01/2018 03/31/2020DR. ROSA MINOKA-HILL SCHOOL, 325 N ROOSEVELT, GREEN BAY, WI 543013

01/10/2020 03/31/2020FOXVIEW INTERMEDIATE SCHOOL, 650 S MICHIGAN, DE PERE, WI 541153

04/01/2018 03/31/2020HEMLOCK CREEK ELEMENTARY SCHOOL, 1900 WILLIAMS GRANT DR, DE PERE, WI 541153

04/01/2018 03/31/2020PHANTOM KNIGHT CHARTER - WEST ACADEMY, 400 REID ST, SUITE W, DE PERE, WI 541153

04/01/2018 03/31/2020WESTWOOD ELEMENTARY SCHOOL, 1155 WESTWOOD, DE PERE, WI 541153

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Mental Health Program Directory By County, City, and Provider Name

2241BELLIN PSYCHIATRIC CENTER BEHAVIORAL HEALTH CLINIC ASHWAUBENON

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/30/2000

(920) 430-4787

(920) [email protected] COUNARD

County: BrownGREEN BAY, WI 543131630 COMMANCHE AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 06/30/2020BELLIN PSYCHIATRIC CENTER - TITLETOWN, 1970 S RIDGE RD, GREEN BAY, WI 543041

07/01/2018 06/30/2020BELLIN PSYCHIATRIC CENTER-ONCOLOGY, 1580 COMMANCHE AVENUE, GREEN BAY, WI 543131

07/01/2018 06/30/2020BELLIN PSYCHIATRIC CENTER-UNITED HEALTHCARE, 3100 AMS BLVD, GREEN BAY, WI 543131

07/01/2018 06/30/2020BELLIN PSYCHIATRIC CENTER - HOWARD, 2714 RIVERVIEW DRIVE, GREEN BAY, WI 543132

07/01/2018 06/30/2020BELLIN PSYCHIATRIC CENTER - PULASKI, 723 S. WISCONSIN STREET, PULASKI, WI 541622

07/01/2018 06/30/2020SEYMOUR COMMUNITY HS & MIDDLE SCHOOL, 10 CIRCLE DRIVE, SEYMOUR, WI 541653

2442BELLIN PSYCHIATRIC CENTER BELLEVUE

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/10/2002

(920) 431-0333

(920) [email protected] COUNARD

County: BrownGREEN BAY, WI 543113263 EATON ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020BELLIN PSYCHIATRIC CENTER-MANITOWOC, 3415 CUSTER ST SUITE D, MANITOWOC, WI 542202

11/01/2018 10/31/2020LUXEMBURG CASCO INTERMEDIATE SCHOOL, 318 N MAIN ST, LUXEMBURG, WI 542173

11/01/2018 10/31/2020LUXEMBURG CASCO MIDDLE SCHOOL, 619 CHURCH AVE, CASCO, WI 542053

07/25/2019 10/31/2020LUXEMBURG CASCO PRIMARY SCHOOL, 601 MARCKS LANE, LUXEMBURG, WI 542173

11/01/2018 10/31/2020SEVASTOPOL SCHOOL DISTRICT, 4550 HIGHWAY 57, STURGEON BAY, WI 542353

2615BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201808/25/2005

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

CCS Affiliaton: 09/01/2014 12/31/2017Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2018 08/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 09/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1117BROWN COUNTY COMMUNITY TREATMENT CTR

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201910/01/1975

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2019 08/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 09/01/2019 11/29/2019

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI 543052

2381BROWN COUNTY HUMAN SERVICES-CSP BROWN COUNTY COMMUNITY TREATMENT CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201906/24/2002

(920) 391-4811

(920) [email protected] AGAR

County: BrownGREEN BAY, WI 543113150 GERSHWIN DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2019 08/31/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 09/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

1140CATHOLIC CHARITIES, DIOCESE OF GREEN BAY, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201901/01/1988

(920) 437-4067

(920) [email protected] J GARDNER

County: BrownGREEN BAY, WI 543011825 RIVERSIDE DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY, 1712 DUNLAP, STE 5, MARINETTE, WI

541432

02/01/2019 01/31/2021EDISON MIDDLE SCHOOL, 442 ALPINE DR, GREEN BAY, WI 543023

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Mental Health Program Directory By County, City, and Provider Name

1329FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201801/12/1996

(920) 437-3540

(920) [email protected] MISCHLER

County: BrownGREEN BAY, WI 54301300 CROOKS STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020FAMILY SERVICES - SOUTH IRWIN, 626 S IRWIN AVENUE, GREEN BAY, WI 543011

04/01/2018 03/31/2020FAMILY SERVICES RESIDENTIAL, 3430 SPIRIT WAY, GREEN BAY, WI 543041

04/01/2018 03/31/2020FAMILY SERVICES WILLOW TREE CHILD ADVOCACY CENTER, 503 S MONROE STREET, GREEN BAY, WI 54301

1

04/01/2018 03/31/2020EAST HIGH SCHOOL, 1415 E WALNUT ST, GREEN BAY, WI 543013

04/01/2018 03/31/2020WRIGHTSTOWN HIGH SCHOOL, 600 HIGH ST, WRIGHTSTOWN, WI 541803

04/01/2018 03/31/2020WRIGHTSTOWN MIDDLE SCHOOL, 400 SCHOOL ST, WRIGHTSTOWN, WI 541803

1332FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201902/01/1984

(920) 433-3383

(920) [email protected] M PELTIER

County: BrownGREEN BAY, WI 54301626 S. IRWIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1035FOUNDATIONS HEALTH AND WHOLENESS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/1981

(920) 437-1188

(920) [email protected] FELD

County: BrownGREEN BAY, WI 543031061 W MASON ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020BOYS AND GIRLS CLUB, 311 S. ONEIDA ST, GREEN BAY, WI 543031

08/09/2019 04/30/2020FREEDOM HOUSE, 840 N TAYLOR ST, GREEN BAY, WI 543031

05/01/2018 04/30/2020NEW COMMUNITY CLINIC - NWTC, 2740 W. MASON ST., GREEN BAY, WI 543071

05/01/2018 04/30/2020NEW COMMUNITY CLINIC, 622 BODART ST, GREEN BAY, WI 543011

05/01/2018 04/30/2020OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI 543031

03/12/2019 04/30/2020AGING & DISABILITY RESOURCE CENTER, 300 S ADAMS ST, GREEN BAY, WI 543032

03/12/2019 04/30/2020BOYS AND GIRLS CLUB, 1451 UNIVERSITY AVE, GREEN BAY, WI 543012

03/12/2019 04/30/2020HOUSE OF HOPE, 1660 CHRISTIANA ST, GREEN BAY, WI 543032

03/12/2019 04/30/2020MICAH CENTER, 700 E WALNUT ST, GREEN BAY, WI 543012

03/12/2019 04/30/2020NEW COMMUNITY SHELTER, 301 MATHER ST, GREEN BAY, WI 543012

Setting Begin/End DatesNon-Certified School Setting(s)05/01/2018 04/30/2020ALDO LEOPOLD SCHOOL, 622 ELIZA ST, GREEN BAY, WI 54301

05/01/2018 04/30/2020BAY VIEW MIDDLE SCHOOL, 1217 CARDINAL LANE, GREEN BAY, WI 54313

05/01/2018 04/30/2020LINEVILLE INTERMEDIATE SCHOOL, 2700 LINEVILLE ROAD, GREEN BAY, WI 54313

2283INNOVATIVE COUNSELING, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201912/14/2000

(920) 498-0476

(920) [email protected] GILBERTSON

County: BrownGREEN BAY, WI 543041499 SIXTH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020INNOVATIVE COUNSELING, INC., 7488 SPRUCE STREET, MINOCQUA, WI 545481

12/17/2019 12/31/2020WASHINGTON ISLAND SCHOOL, 888 MAIN ROAD, WASHINGTON ISLAND, WI 542463

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2019 12/31/2020ASHWAUBENON HIGH SCHOOL, 2391 S RIDGE RD, ASHWAUBENON, WI 54304

01/01/2019 12/31/2020PARKVIEW MIDDLE SCHOOL, 955 WILLARD DR, ASHWAUBENON, WI 54304

01/01/2019 12/31/2020PIONEER ELEMENTARY SCHOOL, 1360 PONDEROSA AVE, GREEN BAY, WI 54313

01/01/2019 12/31/2020VALLEY VIEW ELEMENTARY SCHOOL, 2200 TRUE LN, ASHWAUBENON, WI 54304

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Mental Health Program Directory By County, City, and Provider Name

3270INNOVATIVE SERVICES WELLNESS CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202012/17/201912/17/2019

(920) 273-3371

(920) [email protected] BAUMGART

County: BrownGREEN BAY, WI 543021234 MAIN STREET, 3RD FL

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/17/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/17/2019 12/31/2020INNOVATIVE SVS WELLNESS-FOX VALLEY, 1119 W KENNEDY ST, KIMBERLY, WI 541362

12/17/2019 12/31/2020INNOVATIVE SVS WELLNESS-LA CROSSE, 1052 OAK FOREST DR, STE 360, ONALASKA, WI 546502

2988JACKIE NITSCHKE CENTER, INC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/01/2013

(920) 435-2580

(920) [email protected] JOHNSEN

County: BrownGREEN BAY, WI 54301621 E WALNUT STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020JACKIE NITSCHKE CENTER, INC. ADMIN OFFICES & FAM E, 700 CHERRY STREET, GREEN BAY, WI

543011

1454KA'NI KUHLI'YO FAMILY CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201903/11/1993

(920) 490-3883

(920) [email protected] KRIESCHER

County: BrownGREEN BAY, WI 543032640 WEST POINT ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021ANNA JOHN RESIDENT CENTERED CARE COMMUNITY, 2901 S OVERLAND, ONEIDA, WI 541551

02/01/2019 01/31/2021ONEIDA COMMUNITY HEALTH CENTER, 525 AIRPORT DRIVE, ONEIDA, WI 541551

02/01/2019 01/31/2021ONEIDA NATION VETERAN'S DEPARTMENT, 134 RIVERDALE DR., ONEIDA, WI 541551

02/01/2019 01/31/2021ONEIDA NATION ELEMENTARY SCHOOL, N7125 SEMINARY ROAD, ONEIDA, WI 541553

02/01/2019 01/31/2021ONEIDA NATION HIGH SCHOOL, N7210 SEMINARY ROAD, ONEIDA, WI 541553

02/01/2019 01/31/2021SEYMOUR HIGH SCHOOL SYSTEM, 10 CIRCLE DRIVE, SEYMOUR, WI 541653

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Mental Health Program Directory By County, City, and Provider Name

3025KIMBERLEY WELK AND ASSOCIATES LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/11/2014

(888) 449-6342

(920) [email protected] WELK

County: BrownGREEN BAY, WI 54301926 WILLARD DR #136

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020KIMBERLEY WELK AND ASSOCIATES LLC, 935 S 8TH STREET STE 102, MANITOWOC, WI 542201

06/27/2019 03/31/2020FRANKLIN ELEMENTARY SCHOOL, 800 S 35TH ST, MANITOWOC, WI 542203

06/27/2019 03/31/2020JACKSON ELEMENTARY SCHOOL, 1201 N 18TH ST, MANITOWOC, WI 542203

06/27/2019 03/31/2020JEFFERSON ELEMENTARY SCHOOL, 1415 DIVISION ST, MANITOWOC, WI 542203

08/08/2019 03/31/2020KIEL HIGH SCHOOL, 210 RAIDER HEIGHTS, KIEL, WI 530423

08/08/2019 03/31/2020KIEL MIDDLE SCHOOL, 502 PAINE ST, KIEL, WI 530423

11/12/2018 03/31/2020MANITOWOC PUBLIC HIGH SCHOOL, 1433 S 8TH ST, MANITOWOC, WI 542203

02/01/2019 03/31/2020REEDSVILLE ELEMENTARY/MIDDLE SCHOOL, 350 PARK ST, REEDSVILLE, WI 542303

02/01/2019 03/31/2020REEDSVILLE HIGH SCHOOL, 340 MANITOWOC ST, REEDSVILLE, WI 542303

06/27/2019 03/31/2020STANGEL ELEMENTARY SCHOOL, 1002 E CEDAR AVE, MANITOWOC, WI 542203

04/03/2019 03/31/2020SUNRISE ELEMENTARY SCHOOL, 1414 RHODE ISLAND ST, STURGEON BAY, WI 542353

02/01/2019 03/31/2020VALDERS ELEMENTARY SCHOOL, 331 W WILSON, VALDERS, WI 542453

02/01/2019 03/31/2020VALDERS MIDDLE/HIGH SCHOOL, 138 E WILSON, VALDERS, WI 542453

1669NEW WELLNESS ASSOCIATES, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/1993

(920) 497-3135

(920) [email protected] HOWARD

County: BrownGREEN BAY, WI 543042733 S. RIDGE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021NEW WELLNESS ASSOCIATES, INC., 1941 LEHRER LN, KAUKAUNA, WI 541301

3197NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY – GREEN BAY

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/2018

(844) 380-1192

(920) [email protected] MAURER

County: BrownGREEN BAY, WI 54301123 S VAN BUREN

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2019 01/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

02/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2929POWER FOR CHANGE, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/13/2010

(651) 707-0026

(920) [email protected] SHEFCHIK

County: BrownGREEN BAY, WI 54303123 N OAKLAND AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021POWER FOR CHANGE, LLC I MILWAUKEE, 10201 W LINCOLN AVE #106, WEST ALLIS, WI 532272

3168SBH GREEN BAY, LLC DBA WILLOW CREEK BEHAVIORAL HEALTH

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/10/2017

(920) 469-7213

(920) [email protected] DENIL

County: BrownGREEN BAY, WI 543111351 ONTARIO RD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 02/01/2018 01/31/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 02/01/2018 01/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 3 DHS 40.11(2)(C) 02/01/2018 01/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

3076SPECTRUM BEHAVIORAL HEALTH LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201901/20/2015

(920) 784-2655

(920) [email protected] CARMODY

County: BrownGREEN BAY, WI 543111496 BELLEVUE ST SUITE 101

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

1965VILLA HOPE COMMUNITY SUPPORT PROGRAM OF BROWN COUNTY

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/06/1996

(920) 469-5599

(920) [email protected] TOONEN

County: BrownGREEN BAY, WI 543111100 GUNS ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

BURNETTSIREN

2633ACCESS INC COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2006

(715) 349-7205

(715) [email protected] WOLF

County: BurnettSIREN, WI 5487224248 STATE ROAD 35/70 UNIT D

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

2630BURNETT COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT/ACCESS, INC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2005

(715) 349-2140

(715) [email protected] HOPKE

County: BurnettSIREN, WI 548727410 COUNTY K, #280

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

2493FAMILIES FIRST COUNSELING CENTER, LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202108/01/201901/08/2004

(715) 349-8918

(715) [email protected] HAYMAN

County: BurnettSIREN, WI 5487224178 FIRST AVE SO, SUITE 2

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 01/31/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)08/01/2019 01/31/2021FREDERIC 6-12 SCHOOL, 1437 CLAM FALLS DR, FREDERIC, WI 54837

08/01/2019 01/31/2021GRANTSBURG ELEMENTARY SCHOOL, 475 E JAMES AVE, GRANTSBURG, WI 54840

08/01/2019 01/31/2021GRANTSBURG HIGH SCHOOL, 480 E JAMES AVE, GRANTSBURG, WI 54840

08/01/2019 01/31/2021GRANTSBURG MIDDLE SCHOOL, 500 E JAMES AVE, GRANTSBURG, WI 54840

08/01/2019 01/31/2021WEBSTER 5-12 SCHOOL, 7564 ADLER ST W, WEBSTER, WI 54893

08/01/2019 01/31/2021WEBSTER ELEMENTARY SCHOOL, 7364 ALDER ST E, WEBSTER, WI 54893

2290NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - SIREN

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201802/12/2001

(715) 349-2737

(715) [email protected] MAURER

County: BurnettSIREN, WI 5487224996 STATE ROAD 35

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 04/01/2018 03/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

04/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WEBSTER

2217ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2000

(715) 349-8528

(715) [email protected] LOWE

County: BurnettWEBSTER, WI 548934404 STATE RD 70

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020ROUND LAKE CLINIC, 2230 - 60TH AVENUE, LUCK, WI 548531

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Mental Health Program Directory By County, City, and Provider Name

CALUMETCHILTON

1120CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/01/1975

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 07/01/2018 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020CALUMET COUNTY DEPT OF HUMAN SERVICES, 2306 S. ONEIDA STREET, APPLETON, WI 549152

2244CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2000

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 07/01/2018

11/29/2019

Services

NO BRANCH LOCATIONS

2674CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201906/13/2006

(920) 849-1468

(920) [email protected] LECLAIR

County: CalumetCHILTON, WI 53014206 COURT STREET

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2019 06/30/2021

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 07/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021CCDHHS - APPLETON OFFICE, 2306 S ONEIDA ST, APPLETON, WI 549152

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Mental Health Program Directory By County, City, and Provider Name

CHIPPEWACHIPPEWA FALLS

2424MARRIAGE & FAMILY HEALTH SERVICES, LTD.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201801/01/2003

(715) 726-8731

(715) [email protected] SCHULZ-JOHNSTON

County: ChippewaCHIPPEWA FALLS, WI 54729405 ISLAND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1475ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/12/1977

(715) 717-7504

(715) [email protected] SIMONSON

County: ChippewaCHIPPEWA FALLS, WI 547292661 COUNTY HIGHWAY I

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/01/2018 12/31/2018

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 02/01/2018 01/31/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 02/01/2018 01/31/2020

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 12/31/2018

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 12/31/2018

Services

NO BRANCH LOCATIONS

3066WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2015

(715) 726-4560

(715) [email protected] BARRICKMAN

County: ChippewaCHIPPEWA FALLS, WI 54729711 N BRIDGE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 05/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI

546101

05/01/2018 04/30/2020PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 - 7TH AVE. WEST, DURAND, WI 547361

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Mental Health Program Directory By County, City, and Provider Name

3064WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM - CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2015

(715) 726-7736

(715) [email protected] BARRICKMAN

County: ChippewaCHIPPEWA FALLS, WI 54729711 N BRIDGE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2018 04/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 05/01/2018

11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI

546101

05/01/2018 04/30/2020PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 - 7TH AVE. WEST, DURAND, WI 547361

3065WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2015

(715) 726-7816

(715) [email protected] BARRICKMAN

County: ChippewaCHIPPEWA FALLS, WI 54729711 N BRIDGE STREET

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 04/01/2019 03/31/2021

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 04/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2019 03/31/2021BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S SECOND ST, ALMA, WI 546102

01/01/2020 03/31/2021BURNETT COUNTY DEPT OF HUMAN SERVICES, 7410 CTY RD K, SIREN, WI 548722

04/01/2019 03/31/2021DUNN COUNTY DEPT OF HUMAN SERVICES, 3001 US HWY 12 E, STE 160, MENOMONIE, WI 547512

04/01/2019 03/31/2021PEPIN COUNTY DEPT OF HUMAN SERVICES, 740 7TH AVE WEST, DURAND, WI 547362

04/01/2019 03/31/2021PIERCE COUNTY DEPT OF HUMAN SERVICES, 412 W KINNE ST, ELLSWORTH, WI 540112

04/01/2019 03/31/2021POLK COUNTY HUMAN SERVICES DEPT, 100 POLK COUNTY PLAZA, STE 50, BALSAM LAKE, WI 54810

2

04/01/2019 03/31/2021RUSK COUNTY DEPT OF HEALTH & HUMAN SERVICES, 311 E MINER ST, LADYSMITH, WI 548482

04/01/2019 03/31/2021WASHBURN COUNTY DEPT OF HEALTH AND HUMAN SERVICES, 110 4TH AVENUE, SHELL LAKE, WI 54871

2

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Mental Health Program Directory By County, City, and Provider Name

CLARKNEILLSVILLE

1201CLARK COUNTY COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/1984

(715) 743-5209

(715) [email protected] VOIGT

County: ClarkNEILLSVILLE, WI 54456517 COURT STREET RM 503

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021CLARK COUNTY REHABILITATION AND LIVING CENTER, W4266 STATE HWY 29, OWEN, WI 544602

01/01/2020 12/31/2021GRANTON SCHOOL DISTRICT, 217 N. MAIN STREET, GRANTON, WI 544363

01/01/2020 12/31/2021GREENWOOD ELEMENTARY, 700 EAST DIVISION STREET, GREENWOOD, WI 544373

01/01/2020 12/31/2021GREENWOOD MIDDLE/HIGH SCHOOL, 306 WEST CENTRAL AVENUE, GREENWOOD, WI 544373

01/01/2020 12/31/2021LOYAL SCHOOL DISTRICT, 514 WEST CENTRAL STREET, LOYAL, WI 544463

01/01/2020 12/31/2021NEILLSVILLE ELEMENTARY SCHOOL, 504 EAST 5TH STREET, NEILLSVILLE, WI 544563

01/01/2020 12/31/2021NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 544563

01/01/2020 12/31/2021OWEN-WITHEE SHOOL DISTRICT, 832 WEST 3RD STREET, OWEN, WI 544603

01/01/2020 12/31/2021SCHOOL DISTRICT OF THORP, 605 SOUTH CLARK STREET, THORP, WI 547713

3093CLARK COUNTY COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/2015

(715) 743-5209

(715) [email protected] VOIGT

County: ClarkNEILLSVILLE, WI 54456517 COURT STREET, ROOM 503

CCS Affiliaton: 09/01/2015Begin: End: Lead:CCS of Clark and Trempealeau Counties

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

1202CLARK COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201904/01/1991

(715) 743-5209

(715) [email protected] VOIGT

County: ClarkNEILLSVILLE, WI 54456517 COURT ST, ROOM 503

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

OWEN

3208LIVING WELL MENTAL HEALTH CLINIC, LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2018

(715) 229-0331

(715) [email protected] KOPS

County: ClarkOWEN, WI 54460112 N CENTRAL AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

COLUMBIAPORTAGE

1066ASPEN FAMILY COUNSELING

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/01/2015

(608) 742-3641

(608) [email protected] ERATH

County: ColumbiaPORTAGE, WI 539012639 NEW PINERY ROAD, #1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020ASPEN FAMILY COUNSELING, 120 3RD STREET, BARABOO, WI 539131

01/01/2019 12/31/2020BARABOO HIGH SCHOOL, 1201 DRAPER ST, BARABOO, WI 539133

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2019 12/31/2020CAMBRIA FRIELAND SCHOOL, 410 E EDGEWATER ST, CAMBRIA, WI 53923

01/01/2019 12/31/2020COLUMBUS SCHOOLS, 200 W SCHOOL ST, COLUMBUS, WI 53925

01/01/2019 12/31/2020LODI SCHOOLS, 1100 SAUK ST, LODI, WI 53555

01/01/2019 12/31/2020MONTELLO SCHOOLS, 222 FOREST LN, MONTELLO, WI 53949

01/01/2019 12/31/2020PARDEEVILLE MIDDLE AND HIGH SCHOOL, 120 OAK ST, PARDEEVILLE, WI 53954

01/01/2019 12/31/2020POYNETTE SCHOOLS, 108 N CLEVELAND ST, POYNETTE, WI 53955

01/01/2019 12/31/2020RANDOLPH SCHOOLS, 110 MEADOWOOD DR, RANDOLPH, WI 53956

01/01/2019 12/31/2020WISCONSIN DELLS SCHOOLS, 520 RACE ST, WISCONSIN DELLS, WI 53965

2898COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202006/25/201804/01/2010

(608) 742-9700

(608) [email protected] STARKS

County: ColumbiaPORTAGE, WI 53901111 E MULLETT ST

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/25/2018 03/31/2020

Services

NO BRANCH LOCATIONS

2670COLUMBIA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201907/01/2006

(608) 742-9700

(608) [email protected] WOODARD

County: ColumbiaPORTAGE, WI 53901111 E MULLETT ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2149COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/08/1999

(608) 742-4087

(608) [email protected] STEVENS

County: ColumbiaPORTAGE, WI 539012901 HUNTERS TRAIL

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 1002 LINCOLN AVE, BARABOO, WI 539132

07/01/2018 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 1343 PARK AVE, COLUMBUS, WI 539252

07/01/2018 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 23295 US HWY 14 WEST, RICHLAND CENTER, WI 535812

12/03/2019 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 2702 INTERNATIONAL LN #102, MADISON, WI 537042

07/01/2018 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 50 PRAIRIE AVE, PRAIRIE DU SAC, WI 535782

07/01/2018 06/30/2020COMM SERV ASSOC DBA PAUQUETTE CTR, 710 NORTH WEBB AVE STE 400, REEDSBURG, WI 53959

2

2905COMPASS COUNSELING

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2010

(608) 745-4990

(608) [email protected] KRAVICK

County: ColumbiaPORTAGE, WI 539011508 NEW PINERY RD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/10/2019 04/30/2021RIO MIDDLE SCHOOL/HIGH SCHOOL, 411 CHURCH ST, RIO, WI 539603

3159JOURNEY MENTAL HEALTH CENTER CSP - COLUMBIA CO

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/31/2016

(608) 745-9721

(608) 745-9720dawn.anderson-mueller@journeymhDAWN ANDERSON-MUELLER

County: ColumbiaPORTAGE, WI 539011440 E WISCONSIN AVE

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2915TRANSITIONS BEHAVIORAL HEALTH LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2010

(608) 745-1757

(608) [email protected] BECKETT

County: ColumbiaPORTAGE, WI 53901317 DE WITT ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

CRAWFORDPRAIRIE DU CHIEN

2376CRAWFORD COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201805/01/2002

(608) 326-4395

(608) [email protected] MCWILLIAMS

County: CrawfordPRAIRIE DU CHIEN, WI 53821225 N BEAUMONT ROAD #326

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

1259CRAWFORD COUNTY HEALTH & HUMAN SERVICES DEPARTMENT

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201810/01/1975

(608) 326-4395

(608) [email protected] MCWILLIAMS

County: CrawfordPRAIRIE DU CHIEN, WI 53821225 N BEAUMONT ROAD #326

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/09/2018 03/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/09/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

DANEBELLEVILLE

2508FOUNDATIONS COUNSELING CENTER, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2004

(608) 424-9099

(608) [email protected] KELLY-MARTINA

County: DaneBELLEVILLE, WI 53508619 RIVER STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2019 03/31/2021FOUNDATIONS COUNSELING CENTER - BEAVER DAM, 1807 N CENTER ST SUITE 103, BEAVER DAM,

WI 539161

04/01/2019 03/31/2021FOUNDATIONS COUNSELING CENTER - LODI, 109 FIRST ST., LODI, WI 535551

FITCHBURG

3244ABEGGLEN COUNSELING & CONSULTING, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202001/31/201901/31/2019

(608) 416-1535

(608) [email protected] ABEGGLEN

County: DaneFITCHBURG, WI 537112940 CHAPEL VALLEY RD STE 2

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/31/2019 01/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 01/31/2020MADISON EAST HIGH SCHOOL, 2222 EAST WASHINGTON AVE, MADISON, WI 537113

MADISON

3259ANESIS CENTER FOR MARRIAGE AND FAMILY THERAPY

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202008/28/201908/28/2019

(608) 709-1774

(608) [email protected] MCNAIR

County: DaneMADISON, WI 537196417 ODANA RD STE 5

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/31/2019 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/28/2019 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/28/2019 08/31/2020NORTHSIDE, 2801 INTERNATIONAL LANE, MADISON, WI 537041

1053ARC COMMUNITY SERVICES INC MADISON

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/1995

(608) 283-6374

(608) [email protected] FABICK

County: DaneMADISON, WI 537131409 EMIL STREET #100

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2019 02/28/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1137CATHOLIC CHARITIES, INC. DIOCESE OF MADISON

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201801/01/1979

(608) 826-8027

(608) [email protected] ROBINSON

County: DaneMADISON, WI 53703615 E WASHINGTON AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/11/2018 04/30/2020INDIVIDUAL & FAMILY COUNSELING, FORT ATKINSON, 211 S MAIN ST STE 102, FORT ATKINSON, WI

535381

10/26/2018 04/30/2020BLACK HAWK MIDDLE SCHOOL, 1402 WYOMING WAY, MADISON, WI 537043

01/29/2019 04/30/2020C H BIRD ELEMENTARY SCHOOL, 1170 N BIRD ST, SUN PRAIRIE, WI 535903

05/01/2018 04/30/2020GLENDALE ELEMENTARY SCHOOL, 1201 TOMPKINS DRIVE, MADISON, WI 537163

05/01/2018 04/30/2020LEOPOLD ELEMENTARY SCHOOL, 2602 POST ROAD, MADISON, WI 537133

05/01/2018 04/30/2020MENDOTA ELEMENTARY SCHOOL, 4002 SCHOOL RD, MADISON, WI 537043

01/29/2019 04/30/2020PATRICK MARSH MIDDLE SCHOOL, 1351 COLUMBUS ST, SUN PRAIRIE, WI 535903

05/01/2018 04/30/2020SCHENK ELEMENTARY SCHOOL, 230 SCHENK STREET, MADISON, WI 537143

05/01/2018 04/30/2020SENNETT MIDDLE SCHOOL, 502 PFLAUM RD, MADISON, WI 537163

01/29/2019 04/30/2020WESTSIDE ELEMENTARY SCHOOL, 1320 BEUNA VISTA DR, SUN PRAIRIE, WI 535903

1174CHILD & FAMILY PSYCHOLOGICAL SERVICES CLINIC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201707/01/1982

(608) 288-1892

(608) [email protected] SCHERZ-BUSCH

County: DaneMADISON, WI 53719437 S YELLOWSTONE DR #218

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1188CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/1981

(608) 221-3514

(608) [email protected] LUEBKE

County: DaneMADISON, WI 537041716 FORDEM AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

2407CONNECTIONS COUNSELING

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201901/01/2003

(608) 233-2101

(608) 233-2100shelly.dutch@connectionscounselinSHELLY DUTCH

County: DaneMADISON, WI 537055005 UNIVERSITY AVE SUITE #100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2019 03/31/2021CONNECTIONS COUNSELING, 660 WEST WASHINGTON AVE SUITE 308, MADISON, WI 537032

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Mental Health Program Directory By County, City, and Provider Name

3036DANE COUNTY HUMAN SERVICES CCS

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2015

(608) 242-6413

(608) [email protected] MEISTER

County: DaneMADISON, WI 537041202 NORTHPORT DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

2646DANE COUNTY HUMAN SERVICES DEPT./JOURNEY MENTAL HEALTH CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2006

(608) 280-2707

(608) [email protected] FLANAGAN

County: DaneMADISON, WI 53715702 WEST MAIN ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2019 02/28/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 03/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

1327FAMILY SERVICE MADISON, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201904/01/1977

(608) 252-1333

(608) [email protected] SCHOFF

County: DaneMADISON, WI 53713128 E OLIN AVENUE, #100

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

3028INSIGHT COUNSELING & WELLNESS LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/2014

(608) 244-6809

(608) [email protected] KOLKER

County: DaneMADISON, WI 537042021 ATWOOD AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021INSIGHT COUNSELING & WELLNESS, LLC, 2002 ATWOOD AVE SUITE 205, MADISON, WI 537042

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Mental Health Program Directory By County, City, and Provider Name

2392INTEGRATED DEVELOPMENT SERVICES, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201809/01/2002

(608) 833-0126

(608) [email protected] PARA-CREMER

County: DaneMADISON, WI 53719559 ZOR SHRINE PLACE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020IDS - BROOKFIELD, 4125 N 124TH ST, SUITE A & B, BROOKFIELD, WI 530052

10/01/2018 09/30/2020IDS - EAU CLAIRE, 4330 GOLF TERRACE STE 218, EAU CLAIRE, WI 547012

10/01/2018 09/30/2020IDS - FRANKLIN, 5000 - 5002 (F) W. ASHLAND WAY, FRANKLIN, WI 531322

10/01/2018 09/30/2020IDS - NEW RICHMOND, 1477 SOUTH KNOWLES AVE #105, NEW RICHMOND, WI 540172

1596JOURNEY MENTAL HEALTH CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201810/01/1975

(608) 280-2707

(608) [email protected] LETTMAN SHUE

County: DaneMADISON, WI 5371149 KESSEL COURT

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 02/29/2020JOURNEY MENTAL HEALTH CENTER, INC (JOURNEY EAST), 1320 MENDOTA ST, MADISON, WI 537142

1598JOURNEY MENTAL HEALTH CENTER - FORWARD SOLUTIONS CSP

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201809/01/1990

(608) 280-3185

(608) [email protected] ALBERTSON

County: DaneMADISON, WI 537141320 MENDOTA ST SUITE 120

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2018 10/31/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 11/01/2018

11/29/2019

Services

NO BRANCH LOCATIONS

1599JOURNEY MENTAL HEALTH CENTER GATEWAY COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201909/01/1990

(608) 237-2690

(608) [email protected] KLEIN

County: DaneMADISON, WI 53713208 E OLIN AVE STE 205

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1593JOURNEY MENTAL HEALTH CENTER-COMMUNITY TREATMENT ALTERNATIVES CSP

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/01/1992

(608) 280-2775

(608) [email protected] OLSEN

County: DaneMADISON, WI 537042000 FORDEM AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

1553MADISON PSYCHOTHERAPY CENTER LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201811/01/1993

(608) 233-5893

(608) [email protected] ELLEN MILLER

County: DaneMADISON, WI 53705702 N BLACKHAWK AVENUE #205

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020MADISON PSYCHOTHERAPY CENTER, 111 N MAIN ST STE 200, JANESVILLE, WI 535482

10/01/2018 09/30/2020MADISON PSYCHOTHERAPY CENTER, 702 N BLACKHAWK DRIVE STE 102, MADISON, WI 537052

2738MARRIAGE & FAMILY SOLUTIONS LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/08/2007

(608) 203-6696

(608) [email protected] D'ORAZIO

County: DaneMADISON, WI 537197818 BIG SKY DRIVE #101

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

1013MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201801/01/1984

(608) 417-5334

(608) [email protected] CASE

County: DaneMADISON, WI 53715202 S. PARK STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 12/01/2018 11/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1617MERITER NEWSTART OUTPATIENT CLINIC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201801/01/1988

(608) 417-5334

(608) [email protected] CASE

County: DaneMADISON, WI 537191015 GAMMON LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1668MERITER'S CHILD & ADOLESCENT PSYCHIATRIC HOSPITAL

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202011/06/201901/01/1984

(608) 417-5334

(608) [email protected] CASE

County: DaneMADISON, WI 537198102 WELLNESS WAY

Service Begin/End DatesAdm Code

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 11/06/2019 11/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 3 DHS 40.11(2)(C) 11/06/2019 11/30/2020

Services

NO BRANCH LOCATIONS

3266NEXT STEPS

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202010/08/201910/08/2019

(605) 252-1333

(608) [email protected] MURPHY

County: DaneMADISON, WI 53713206 EAST OLIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/08/2019 10/31/2020

Services

NO BRANCH LOCATIONS

1685NORTHSTAR COUNSELING CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/1991

(608) 270-1965

(608) [email protected] PATTI

County: DaneMADISON, WI 537116506 SCHROEDER RD

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

2026OPEN DOOR CENTER FOR CHANGE LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/1996

(608) 827-7223

(608) [email protected] DOUGLAS

County: DaneMADISON, WI 537196502 GRAND TETON PLAZA #102

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020OPEN DOOR CENTER FOR CHANGE, 3324 MILWAUKEE ST C2-C3, MADISON, WI 537142

2309ORION FAMILY SERVICES, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201807/12/2001

(608) 270-0467

(608) [email protected] PARKE

County: DaneMADISON, WI 537196333 ODANA ROAD, #20

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/12/2018 07/31/2020ORION FAMILY SERVICES, 1725 15TH STREET, MONROE, WI 535661

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Mental Health Program Directory By County, City, and Provider Name

1750PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT (PACT)

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/01/1989

(608) 266-3638

(608) [email protected] LANE FREY

County: DaneMADISON, WI 53703600 WILLIAMSON STREET, #A-B

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

3274REFLECTIONS MENTAL HEALTH, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202012/23/201912/23/2019

() -

(608) [email protected] MAHAN-STRUPP

County: DaneMADISON, WI 537132802 COHO STE 203

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/23/2019 12/31/2020

Services

NO BRANCH LOCATIONS

1786REGENT MENTAL HEALTH GROUP

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/1979

(608) 238-1221

(608) [email protected] RILEY

County: DaneMADISON, WI 537196515 WATTS ROAD #206

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

2920ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/13/2010

(608) 238-4412

(608) [email protected] SCHULTZ

County: DaneMADISON, WI 53711406 SCIENCE DRIVE RM #110 & 200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2019 10/31/2021

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 11/01/2019 11/29/2019

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-DAY TREATMENT DHS 61.75 11/01/2019 10/31/2021

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 11/01/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 11/01/2019 10/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B)

11/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3096SOAR CASE MANAGEMENT

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202006/01/201807/02/2015

(608) 287-0840

(608) [email protected] ZEMLO

County: DaneMADISON, WI 537042132 FORDEM AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1872ST. MARY'S HOSPITAL MEDICAL CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202001/22/201906/01/1983

(608) 259-5317

(608) [email protected] MIGNON

County: DaneMADISON, WI 53715700 S PARK ST, 6W

Service Begin/End DatesAdm Code

MENTAL HEALTH-INPATIENT DHS 61.71 01/22/2019 05/31/2020

Services

NO BRANCH LOCATIONS

1147THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/1982

(608) 274-8783

(608) [email protected] RANDALL

County: DaneMADISON, WI 537185310 WALL STREET, #500

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020THE CTR CHRISTIAN CNSLNG CONS, 208 E MILWAUKEE AVENUE, FORT ATKINSON, WI 535381

2857THE FAMILY CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201807/02/2009

(608) 664-9854

(608) [email protected] CULVER

County: DaneMADISON, WI 537178025 EXCELSIOR DRIVE, #110

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020YWCA MADISON, 101 E MIFFLIN ST, MADISON, WI 537031

1914THE INTEGRAL PSYCHOLOGY CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/1979

(608) 255-7810

(608) [email protected] CUNNINGHAM

County: DaneMADISON, WI 537111619 MONROE ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1919THE PSYCHOLOGY CLINIC, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/01/1991

(608) 238-1929

(608) [email protected] BLACK, PHD

County: DaneMADISON, WI 53705310 N MIDVALE BOULEVARD #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 10/31/2020THE PSYCHOLOGY CLINIC, INC - ODANA, 5555 ODANA RD STE 202, MADISON, WI 537191

11/01/2018 10/31/2020THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 13, WISCONSIN DELLS, WI 539651

11/01/2018 10/31/2020THE PSYCHOLOGY CLINIC, INC - BARABOO, 701 ASH STREET, BARABOO, WI 539132

11/01/2018 10/31/2020THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC, 1190 PRAIRIE ST, PRAIRIE DU SAC, WI 535782

1920THE RAINBOW PROJECT, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201905/01/1988

(608) 255-0457

(608) [email protected] KATO

County: DaneMADISON, WI 53703831 E. WASHINGTON AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021REACH DANE, 2096 RED ARROW TR, MADISON, WI 537111

1940UNIVERSITY OF WI HOSPITALS & CLINICS

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201811/01/1990

(608) 263-9045

(608) [email protected] GREEN

County: DaneMADISON, WI 53713122 E. OLIN AVENUE, #275

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1953UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201901/01/1987

(608) 662-3050

(608) [email protected] SMITH-HELMENSTINE

County: DaneMADISON, WI 53792600 HIGHLAND AVE, 1085 AOB

Service Begin/End DatesAdm Code

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3228WESTSIDE PSYCHOTHERAPY, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/20/201808/20/2018

(608) 236-4461

(608) [email protected] EUGSTER

County: DaneMADISON, WI 537054513 VERNON BLVD, STE 100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/20/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/20/2018 07/31/2020WESTSIDE PSYCHOTHERAPY, AT CAPITOL LAKES, 333 W MAIN ST, MADISON, WI 537031

08/20/2018 07/31/2020WESTSIDE PSYCHOTHERAPY, LLC ON THE SQUARE, 16 N CARROLL ST, STE 530, MADISON, WI 53713

2

08/20/2018 07/31/2020WESTSIDE PSYCHOTHERAPY, LLC WEST TOWNE, 414 DONOFRIO DR STE 330, MADISON, WI 537192

2000WISCONSIN PSYCHOTHERAPY AND HEALING CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/1993

(608) 288-8977

(608) [email protected] MCKEE

County: DaneMADISON, WI 537196401 ODANA ROAD SUITE 13

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

MC FARLAND

2779COMMON THREADS FAMILY RESOURCE CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201904/01/2008

(608) 838-8988

(608) [email protected] EGGEN

County: DaneMC FARLAND, WI 535584800 IVYWOOD TRAIL

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

MIDDLETON

1220COMMUNITY CARE PROGRAMS, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201902/01/1994

(608) 827-7101

(608) [email protected] SIMON

County: DaneMIDDLETON, WI 535626716 STONE GLEN DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/24/2019 03/31/2021COLUMBIA CO HHS, 111 E MULLETT ST, PORTAGE, WI 539011

04/01/2019 03/31/2021JEFFERSON CO DEPT OF HUMAN SVS, 1541 ANNEX ROAD, JEFFERSON, WI 535491

04/01/2019 03/31/2021ROCK CO DEPT OF HUMAN SVS, 3530 N COUNTY TRK HWY F, JANESVILLE, WI 535471

12/09/2019 03/31/2021SAUK CO HUMAN SVS- THERAPY WITHOUT WALLS, 348 E MAIN ST, REEDSBURG, WI 539591

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Mental Health Program Directory By County, City, and Provider Name

1222COMMUNITY COUNSELING CENTER OF MADISON, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/1998

(608) 829-3787

(608) [email protected] OLSON

County: DaneMIDDLETON, WI 535626629 UNIVERSITY AVENUE, #209

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

MONONA

3137ECLIPSE COUNSELING, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/201908/01/201708/01/2016

(608) 221-2586

(608) [email protected] KEENE

County: DaneMONONA, WI 537164915 MONONA DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2017 07/31/2019

Services

NO BRANCH LOCATIONS

1822SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201909/01/1994

(608) 663-0765

(608) 663-0763dfeaster@samaritancounselingcenteDAN FEASTER

County: DaneMONONA, WI 537165900 MONONA DRIVE #100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021WEST MADISON - GOOD SHEPHERD LUTHERAN CHURCH, 5701 RAYMOND RD, MADISON, WI 537111

3010SANKOFA BEHAVIORAL & COMMUNITY HEALTH

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/01/2013

(608) 467-9635

(608) [email protected] HENDERSON, PHD

County: DaneMONONA, WI 537131945 W BROADWAY STE 105

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

1901TELLURIAN OUTPATIENT CLINIC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201904/27/2011

(608) 222-5904

(608) [email protected] CROOKS

County: DaneMONONA, WI 53716300 FEMRITE DR - 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-INTERVENTION DHS 75.16 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

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

OREGON

2513OREGON MENTAL HEALTH SERVICES, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2004

(608) 835-5010

(608) [email protected] SELLA

County: DaneOREGON, WI 53575165 W NETHERWOOD ST, STE A

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 04/30/2021OREGON MENTAL HEALTH SERVICES LLC, 101 FOUNTAIN ST, STE 2, DODGEVILLE, WI 535331

Setting Begin/End DatesNon-Certified School Setting(s)05/01/2019 04/30/2021BARNEVELD SCHOOL K-12, 304 S JONES ST, BARNEVELD, WI 53507

05/01/2019 04/30/2021BELMONT SCHOOL K-12, 646 E LIBERTY ST, BELMONT, WI 53510

05/01/2019 04/30/2021BROOKLYN ELEMENTARY SCHOOL, 204 DIVISION ST, BROOKLYN, WI 53521

05/01/2019 04/30/2021IOWA GRANT SCHOOL K-12, 498 COUNTY RD IG, LIVINGSTON, WI 53554

05/01/2019 04/30/2021MOUNT HOREB HIGH SCHOOL, 305 S 8TH ST, MOUNT HOREB, WI 53572

05/01/2019 04/30/2021MOUNT HOREB MIDDLE SCHOOL, 900 E GARFIELD ST, MOUNT HOREB, WI 53572

05/01/2019 04/30/2021NETHERWOOD KNOLL ELEMENTARY, 276 SODEN DRIVE, FITCHBURG, WI 53575

05/01/2019 04/30/2021OREGON HIGH SCHOOL, 456 N PERRY PARKWAY, OREGON, WI 53575

05/01/2019 04/30/2021OREGON MIDDLE SCHOOL, 601 PLEASANT OAK DRIVE, OREGON, WI 53575

05/01/2019 04/30/2021PECATONICA SCHOOL K-12, 704 CROSS ST, BLANCHARDVILLE, WI 53516

05/01/2019 04/30/2021PRAIRIE VIEW ELEMENTARY SCHOOL, 30 SODEN DRIVE, OREGON, WI 53575

05/01/2019 04/30/2021RIVER VALLEY SCHOOLS K-12, 60 W DALEY ST, SPRING GREEN, WI 53588

05/01/2019 04/30/2021ROME CORNERS INTERMEDIATE SCHOOL, 1111 S PERRY PARKWAY, OREGON, WI 53575

STOUGHTON

2675OCEANHAWK COUNSELING ALTERNATIVES, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/17/2006

(877) 674-2177

(608) [email protected] DAUTE

County: DaneSTOUGHTON, WI 535893185 DEER POINT DR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

1884STOUGHTON HOSPITAL

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/1997

(608) 873-2339

(608) [email protected] KLEINBROOK

County: DaneSTOUGHTON, WI 53589900 RIDGE STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2019 08/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SUN PRAIRIE

2916HEALING HEARTS FAMILY COUNSELING CENTER, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/20/2010

(702) 664-6958

(608) [email protected] ANN ST. GERMAIN

County: DaneSUN PRAIRIE, WI 535901268 W MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

3227MERCYLAND PSYCHIATRY INC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201911/28/2018

(608) 318-2234

(608) [email protected] MOFIKOYA

County: DaneSUN PRAIRIE, WI 53590530 W MAIN STREET #5

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

1742PRAIRIE COUNSELING SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201807/01/1978

(608) 825-4933

(608) [email protected] HUBBARD

County: DaneSUN PRAIRIE, WI 535901460 W MAIN ST #150

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

2868TRIVIUM DBA CROSSROADS COUNSELING CENTER

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201908/18/2009

(608) 837-9191

(608) [email protected] PERRY

County: DaneSUN PRAIRIE, WI 53590722-728 LOIS DR

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 09/01/2019 08/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

09/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

DODGEBEAVER DAM

1018AFFILIATED COUNSELING CENTER, LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201911/01/1989

(920) 887-3977

(920) 887-8751officemanager@affiliatedcounselingSANDRA SCHWEFEL-MASSIE

County: DodgeBEAVER DAM, WI 539161807 N CENTER ST, #204

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI 549351

3106CHURCH HEALTH SERVICES, INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/17/2015

(920) 887-2322

(920) [email protected] KEMPFER

County: DodgeBEAVER DAM, WI 53916115 N CENTER STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)11/01/2019 10/31/2021BEAVER DAM HIGH SCHOOL, 500 GOULD ST, BEAVER DAM, WI 53916

11/01/2019 10/31/2021BEAVER DAM MIDDLE SCHOOL, 108 FOURTH STREET, BEAVER DAM, WI 53916

11/01/2019 10/31/2021BEAVER DAM USD ADMIN BLDG, 705 MCKINLEY STREET, BEAVER DAM, WI 53916

11/01/2019 10/31/2021DON SMITH LEARNING ACADEMY, 400 E BURNETT STREET, BEAVER DAM, WI 53916

11/01/2019 10/31/2021HORICON JR/SR HIGH SCHOOL, 841 GRAY ST, HORICON, WI 53032

11/01/2019 10/31/2021JEFFERSON ELEMENTARY, 301 BROOK ST, BEAVER DAM, WI 53916

11/01/2019 10/31/2021LINCOLN ELEMENTARY, 210 GOULD ST, BEAVER DAM, WI 53916

11/01/2019 10/31/2021MEADOW VIEW PRIMARY SCHOOL, 601 GRANDVIEW AVE, WAUPUN, WI 53963

11/01/2019 10/31/2021PRAIRIE VIEW ELEMTARY, 510 N CRYSTAL LAKE ROAD, BEAVER DAM, WI 53916

11/01/2019 10/31/2021ROCK RIVER INTERMEDIATE SCHOOL, 451 E SPRING ST, WAUPUN, WI 53963

11/01/2019 10/31/2021SAGES, 200 S DEPOT ST, FOX LAKE, WI 53933

11/01/2019 10/31/2021SO BEAVER DAM ELEMENTARY, W9787 COUNTY ROAD D, BEAVER DAM, WI 53916

11/01/2019 10/31/2021ST KATHERINE DREXEL SCHOOL, 503 S SPRING ST, BEAVER DAM, WI 53916

11/01/2019 10/31/2021WASHINGTON ELEMENTARY, 600 GROVE STREET, BEAVER DAM, WI 53916

11/01/2019 10/31/2021WAUPUN EDUCATION SERVICE CENTER, 900 WILCOX ST, WAUPUN, WI 53963

11/01/2019 10/31/2021WAUPUN JR/SR HIGH SCHOOL, 801 LINCOLN ST, WAUPUN, WI 53963

11/01/2019 10/31/2021WILSON ELEMENTARY, 405 W 3RD STREET, BEAVER DAM, WI 53916

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Mental Health Program Directory By County, City, and Provider Name

JUNEAU

2764DODGE COUNTY HUMAN SERVICES & HEALTH DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/11/2007

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY RD DF

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

1282DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201910/01/1975

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY RD DF

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2019 02/28/2021

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2019 02/28/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2019 02/28/2021

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021LOMIRA SCHOOL, 1030 4TH ST., LOMIRA, WI 530483

03/01/2019 02/28/2021MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI 530503

03/01/2019 02/28/2021MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 3013, MAYVILLE, WI 530503

03/01/2019 02/28/2021ROCK RIVER INTERMEDIATE SCHOOL, 451 E. SPRING ST. RM 153 B, WAUPUN, WI 539633

03/01/2019 02/28/2021VAN BRUNT ELEMENTARY, 611 MILL ST. RM 447, HORICON, WI 530323

2100DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201901/01/1999

(920) 386-3812

(920) [email protected] SCHULTZ

County: DodgeJUNEAU, WI 53039199 COUNTY ROAD DF

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WATERTOWN

1278WATERTOWN PHYSICIAN PRACTICES, LLC DBA WRMC DIRECTIONS COUNSELING CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202011/01/1981

(920) 262-4813

(920) [email protected] NOVOTNY

County: DodgeWATERTOWN, WI 53098123 HOSPITAL DRIVE SUITE 110

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021WRMC DOCTOR'S COURT CLINIC, 1507 DOCTOR'S COURT, WATERTOWN, WI 530941

01/01/2020 12/31/2021WRMC JOHNSON CREEK CLINIC, 540J VILLAGE WALK LANE, JOHNSON CREEK, WI 530381

01/01/2020 12/31/2021WRMC JUNEAU CLINIC, 334 S WESTERN AVENUE, JUNEAU, WI 530391

01/01/2020 12/31/2021WRMC LAKE MILLS CLINIC, 1025 MULBERRY STREET, LAKE MILLS, WI 535511

01/01/2020 12/31/2021WRMC WATERLOO CLINIC, 111 ANNA ST, WATERLOO, WI 535941

WAUPUN

3216WAUPUN MEMORIAL HOSPITAL INC DBA OUTPATIENT BEHAVIORAL HEALTH AT WAUPUN

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201804/13/2018

(920) 324-8459

(920) [email protected] DOLL

County: DodgeWAUPUN, WI 53963620 W BROWN ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

DOORSTURGEON BAY

2871BAY COUNSELING CLINIC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2009

(920) 743-4681

(920) [email protected] GRAHL

County: DoorSTURGEON BAY, WI 5423550 SOUTH MADISON AVE SUITE 3

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1250COUNSELING ASSOCIATES OF DOOR COUNTY LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201811/16/1993

(920) 743-1591

(920) [email protected] BURLO

County: DoorSTURGEON BAY, WI 54235312 N 5TH AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020SOUTHERN DOOR SCHOOLS, 2073 COUNTY RD N, BRUSSELS, WI 542043

1283DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202001/01/201901/01/1978

(920) 746-2439

(920) [email protected] ALTEPETER

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 09/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 01/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2019 09/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 01/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

3057DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES - CCS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/01/2014

(920) 746-2439

(920) [email protected] MCFARLANE

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2159DOOR COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201910/01/1999

(920) 746-2439

(920) [email protected] FLORES

County: DoorSTURGEON BAY, WI 54235421 NEBRASKA STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

3139DOOR COUNTY MEMORIAL HOSPITAL DBA DOOR COUNTY MEDICAL CENTER CLINICS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/06/2016

(920) 746-0099

(920) [email protected] JOHNSON-GIESE

County: DoorSTURGEON BAY, WI 54235323 S 18TH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021DOOR CO MED CTR CLINIC - ALGOMA, 815 JEFFERSON ST, ALGOMA, WI 542011

09/01/2019 08/31/2021DOOR CO MED CTR CLINIC - FISH CREEK, 3711 HIGHWAY 42, FISH CREEK, WI 542121

09/01/2019 08/31/2021STURGEON BAY HIGH SCHOOL, 1230 MICHIGAN ST, STURGEON BAY, WI 542353

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Mental Health Program Directory By County, City, and Provider Name

DOUGLASSUPERIOR

2964DOUGLAS CO DEPT HLTH & HUMAN SVS/HUMAN DEVELOPMENT CTR

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2010

(715) 392-6055

(715) [email protected] ENGLESON

County: DouglasSUPERIOR, WI 548801500 N 34TH STREET, #100

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 2 DHS 34.2 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

2312HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/01/1982

(715) 392-6055

(715) [email protected] ENGLESON

County: DouglasSUPERIOR, WI 548801500 N 34TH ST #100

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3195LAKE SUPERIOR COMMUNITY HEALTH CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/05/2018

(715) 392-1935

(715) [email protected] BYLER

County: DouglasSUPERIOR, WI 548803600 TOWER AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021LSCHC OP MH/AODA OFFICE, 1500 N 34TH STREET #200, SUPERIOR, WI 548802

Setting Begin/End DatesNon-Certified School Setting(s)02/01/2019 01/31/2021BRYANT ELEMENTARY, 1423 CENTRAL AVE, SUPERIOR, WI 54880

02/01/2019 01/31/2021LAKE SUPERIOR ELEMENTARY, 3200 E 3RD ST, SUPERIOR, WI 54880

02/01/2019 01/31/2021NORTHWESTERN HIGH SCHOOL, 4751 S COUNTY RD F, MAPLE, WI 54854

02/01/2019 01/31/2021SOLON SPRINGS, 8993 E BALDWIN AVE, SOLON SPRINGS, WI 54873

02/01/2019 01/31/2021SUPERIOR HIGH SCHOOL, 2600 CATLIN AVE, SUPERIOR, WI 54880

02/01/2019 01/31/2021SUPERIOR MIDDLE SCHOOL, 3626 HAMMOND AVE, SUPERIOR, WI 54880

3105NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - NORTHERN LIGHTS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/11/2016

(715) 394-2869

(715) [email protected] MAURER

County: DouglasSUPERIOR, WI 548801201 N 28TH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 01/01/2019 12/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

01/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3238SMHS PARTIAL HOSPITALIZATION PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/22/201903/22/2019

(218) 722-0373

(218) [email protected] BRUNETTE

County: DouglasSUPERIOR, WI 548803500 TOWER AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT DHS 61.75 03/22/2019 02/29/2020

Services

NO BRANCH LOCATIONS

3111THE CREATIVE COUNSELING GROUP, LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/11/2015

(715) 718-5607

(715) [email protected] MATTSON

County: DouglasSUPERIOR, WI 548803215 TOWER AVENUE, STE 108

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

DUNNMENOMONIE

1050ARBOR PLACE, INC.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201912/01/1993

(715) 235-4535

(715) [email protected] GAMEZ

County: DunnMENOMONIE, WI 547514076 KOTHLOW AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2019 09/30/2021

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 10/01/2019 09/30/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

CSAS-PREVENTION DHS 75.04 10/01/2019 09/30/2021

CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 10/01/2019 09/30/2021

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021ARBOR PLACE, INC - RIVER FALLS, 103 S SECOND ST, RIVER FALLS, WI 540222

1287DUNN COUNTY DEPARTMENT OF HUMAN SERVICES BEHAVIORAL HEALTH SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201801/01/1981

(715) 232-5987

(715) [email protected] WINGER

County: DunnMENOMONIE, WI 547513001 US HWY 12 EAST SUITE 160

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 06/01/2018 05/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 08/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2055DUNN COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/1998

(715) 232-5987

(715) [email protected] WINGER

County: DunnMENOMONIE, WI 547513001 US HWY 12 EAST, SUITE 160

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

1780MAYO CLINIC HEALTH SYSTEM RED CEDAR

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/01/1992

(715) 233-7897

(715) [email protected] FISCHER

County: DunnMENOMONIE, WI 547512411 STOUT ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2660NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - MENOMONIE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2006

(888) 293-7837

(715) [email protected] MAURER

County: DunnMENOMONIE, WI 54751402 TECHNOLOGY DR E

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 03/01/2018 02/29/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

03/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

EAU CLAIREALTOONA

2733AUTISM AND BEHAVIOR CENTER, INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/29/2007

(715) 598-7123

(715) [email protected] WEGNER

County: Eau ClaireALTOONA, WI 54720919 S HILLCREST PKWY

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

EAU CLAIRE

1119CAILLIER CLINIC, LTD.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201801/01/1983

(715) 836-0065

(715) [email protected] CAILLIER

County: Eau ClaireEAU CLAIRE, WI 547012620 STEIN BLVD STE B

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 210, MENOMONIE, WI 547511

12/01/2018 11/30/2020CAILLIER CLINIC, LTD, 138 N. MAIN ST SUITE 206, RICE LAKE, WI 548682

Setting Begin/End DatesNon-Certified School Setting(s)12/01/2018 11/30/2020COLFAX MIDDLE SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730

1186CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202009/01/1983

(715) 835-8112

(715) [email protected] OERTER

County: Eau ClaireEAU CLAIRE, WI 547012004 HIGHLAND AVE SUITE M

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021BLACK RIVER FALLS HEAD START CENTER, 905 ALDER ST, BLACK RIVER FALLS, WI 546151

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2020 12/31/2021ALTOONA HIGH SCHOOL, 711 7TH STREET WEST, ALTOONA, WI 54720

01/01/2020 12/31/2021ALTOONA MIDDLE SCHOOL, 1903 BARTLETT AVE, ALTOONA, WI 54720

01/01/2020 12/31/2021LOCUST LANE ELEMENTARY, 3245 LOCUST LANE, EAU CLAIRE, WI 54703

01/01/2020 12/31/2021MANZ ELEMENTARY, 1000 EAST FILLMORE AVE, EAU CLAIRE, WI 54701

01/01/2020 12/31/2021ROOSEVELT ELEMENTARY SCHOOL, 3010 8TH STREET, EAU CLAIRE, WI 54703

01/01/2020 12/31/2021SAM DAVEY ELEMENTARY, 3000 STARR AVE, EAU CLAIRE, WI 54703

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Mental Health Program Directory By County, City, and Provider Name

3240CLINIC FOR CHRISTIAN COUNSELING, LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202005/01/2018

(715) 832-6680

(715) [email protected] STEIN

County: Eau ClaireEAU CLAIRE, WI 547013410 OAKWOOD MALL DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021CLINIC FOR CHRISTIAN COUNSELING, LLC, 12 W MARSHALL ST, STE 201, RICE LAKE, WI 548682

01/01/2020 12/31/2021CRESTVIEW ACADEMY, 1519 PETERSON AVE, EAU CLAIRE, WI 547033

2815EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/09/2008

(715) 831-5658

(715) [email protected] FEDIE

County: Eau ClaireEAU CLAIRE, WI 54701721 OXFORD AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

3112EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES - CCS PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2016

(715) 831-5784

(715) [email protected] STEIN

County: Eau ClaireEAU CLAIRE, WI 54703721 OXFORD AVENUE

CCS Affiliaton: 01/01/2019Begin: End: Lead:BESt CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

1293EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201801/01/1990

(715) 831-5783

(715) [email protected] CABLE

County: Eau ClaireEAU CLAIRE, WI 54703721 OXFORD AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3178ENIGMA PSYCHOLOGICAL INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202003/01/201909/01/2017

(715) 598-6222

(715) [email protected] GIRARD

County: Eau ClaireEAU CLAIRE, WI 547014330 GOLF TERRACE #209

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 08/31/2020

Services

NO BRANCH LOCATIONS

2993GREAT LAKES BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201903/01/2013

(715) 834-9954

(715) [email protected] PLOTZ

County: Eau ClaireEAU CLAIRE, WI 54703550 NORTH DEWEY STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021MILWAUKEE ACADEMY, 8915 W CAPITOL DR, MILWAUKEE, WI 532221

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2019 08/31/2021EAU CLAIRE ACADEMY, 550 N DEWEY ST, EAU CLAIRE, WI 54703

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2797LSS OF WI & UPPER MI FAMILY PRESERVATION PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/30/2008

(715) 838-8423

(715) [email protected] CHRISTIANSON

County: Eau ClaireEAU CLAIRE, WI 54701120 S BARSTOW STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

07/01/2019 06/30/2021ABBOTSFORD ELEMENTARY SCHOOL, 510 W. HEMLOCK ST, ABBOTSFORD, WI 54405

07/01/2019 06/30/2021ABBOTSFORD MIDDLE AND HIGH SCHOOL, 307 N 4TH AVE, ABBOTSFORD, WI 54405

07/01/2019 06/30/2021ALTOONA ELEMENTARY SCHOOL, 157 BARTLETT AVE, ALTOONA, WI 54720

07/01/2019 06/30/2021ALTOONA HIGH SCHOOL, 711 7TH ST W, ALTOONA, WI 54720

07/01/2019 06/30/2021ALTOONA MIDDLE SCHOOL, 1903 BARTLETT AVE, ALTOONA, WI 54720

07/01/2019 06/30/2021BARRON HIGH SCHOOL, 1050 EAST WOODLAND AVE, BARRON, WI 54812

07/01/2019 06/30/2021BLOOMER ELEMENTARY, 401 8TH STREET, BLOOMER, WI 54724

07/01/2019 06/30/2021BLOOMER HIGH SCHOOL, 1310 17TH AVE, BLOOMER, WI 54724

07/01/2019 06/30/2021BLOOMER MIDDLE SCHOOL, 600 JACKSON ST, BLOOMER, WI 54724

07/01/2019 06/30/2021CADDY WOODLAWN ELEMENTARY SCHOOL, 650 AUTH ST, DURAND, WI 54736

07/01/2019 06/30/2021CADOTT ELEMENTARY SCHOOL, 463 E MILLS ST, CADOTT, WI 54727

07/01/2019 06/30/2021CADOTT JUNIOR/SENIOR HIGH SCHOOL, 426 MYRTLE ST, CADOTT, WI 54727

07/01/2019 06/30/2021CAMERON ELEMENTARY SCHOOL, 919 NORTH 2ND ST, CAMERON, WI 54822

07/01/2019 06/30/2021CAMERON HIGH SCHOOL, 750 1ST ST, CAMERON, WI 54822

07/01/2019 06/30/2021CAMERON MIDDLE SCHOOL, 700 SOUTH 1ST ST, CAMERON, WI 54822

07/01/2019 06/30/2021CHETEK-WEYERHAUSER MIDDLE AND HIGH SCHOOL, 1001 KNAPP ST, CHETEK, WI 54728

07/01/2019 06/30/2021CHIPPEWA FALLS HIGH SCHOOL, 735 TERRILL ST, CHIPPEWA FALLS, WI 54729

07/01/2019 06/30/2021CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA BLVD, CHIPPEWA FALLS, WI 54729

07/01/2019 06/30/2021CORNELL ELEMENTARY, 111 SOUTH 4TH STREET, CORNELL, WI 54732

07/01/2019 06/30/2021CORNELL MIDDLE/HIGH SCHOOL, 708 BRIDGE STREET, CORNELL, WI 54732

07/01/2019 06/30/2021DELONG MIDDLE SCHOOL, 2000 VINE ST, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021DURAND-ARKANSAW MIDDLE/HIGH SCHOOL, 604 7TH AVE, DURAND, WI 54736

07/01/2019 06/30/2021GILMAN ELEMENTARY AND HIGH SCHOOL, 325 N. 5TH AVE., GILMAN, WI 54433

07/01/2019 06/30/2021GRANTON ELEMENTARY, MIDDLE, AND HIGH SCHOOL, 217 N MAIN ST, GRANTON, WI 54436

07/01/2019 06/30/2021GRANTSBURG MIDDLE SCHOOL, 500 E JAMES AVE, GRANTSBURG, WI 54840

07/01/2019 06/30/2021HAUGEN ELEMENTARY, MIDDLE AND HIGH SCHOOL, 615 WEST 5TH ST, HAUGEN, WI 54841

07/01/2019 06/30/2021HILLTOP ELEMENTARY SHOOL, 202 CAMERON RD, RICE LAKE, WI 54868

07/01/2019 06/30/2021HOLY GHOST ELEMENTARY SCHOOL, 436 MAIN ST, CHIPPEWA FALLS, WI 54729

07/01/2019 06/30/2021LADYSMITH ELEMENTARY SCHOOL, 115 E 6TH ST S, LADYSMITH, WI 54848

07/01/2019 06/30/2021LADYSMITH MIDDLE AND HIGH SCHOOL, 1700 EDGEWOOD AVE E, LADYSMITH, WI 54848

07/01/2019 06/30/2021LONGFELLOW ELEMENTARY SCHOOL, 500 BALCOM ST, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021MANZ ELEMENTARY SCHOOL, E FILLMORE AVE, EAU CLAIRE, WI 54701

07/01/2019 06/30/2021MEMORIAL HIGH SCHOOL, 2225 KEITH ST, EAU CLAIRE, WI 54701

07/01/2019 06/30/2021NEILLSVILLE ELEMENTARY SCHOOL, 614 EAST 5TH ST, NEILLSVILLE, WI 54456

07/01/2019 06/30/2021NEILLSVILLE MIDDLE AND HIGH SCHOOL, 401 CENTER ST, NEILLSVILLE, WI 54456

07/01/2019 06/30/2021NEW AUBURN ELEMENTARY, MIDDLE, AND HIGH SCHOOL, 704 N EAST ST, NEW AUBURN, WI 54757

07/01/2019 06/30/2021NORTH HIGH SCHOOL, 1801 PIEDMONT AVENUE, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021NORTHSTAR MIDDLE SCHOOL, 2711 ABBE HILL DR, EAU CLAIRE, WI 54701

07/01/2019 06/30/2021NORTHWOODS ELEMENTARY SCHOOL, 3600 NORTHWOODS LN, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021NOTRE DAME MIDDLE SCHOOL/MCDONNELL HIGH SCHOOL, 1316 BEL AIR BLVD, CHIPPEWA FALLS, WI 54729

07/01/2019 06/30/2021OSSEO-FAIRCHILD ELEMENTARY SCHOOL, 513025 15TH ST, OSSEO, WI 54758

07/01/2019 06/30/2021OSSEO-FAIRCHILD MIDDLE AND HIGH SCHOOL, 5085 EAST ST, OSSEO, WI 54758

07/01/2019 06/30/2021PUTNAM ELEMENTARY SCHOOL, 633 W MACARTHUR AVE, EAU CLAIRE, WI 54701

07/01/2019 06/30/2021RICE LAKE HIGH SCHOOL, 305 WISCONSIN AVENUE, RICE LAKE, WI 54868

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07/01/2019 06/30/2021RICE LAKE MIDDLE SCHOOL, 204 CAMERON RD, RICE LAKE, WI 54868

07/01/2019 06/30/2021RIDGELAND/DALLAS SCHOOLS, 315 MAIN STREET, RIDGELAND, WI 54763

07/01/2019 06/30/2021RIVER HEIGHTS ELEMENTARY SCHOOL, 615 24TH AVE W, MENOMONIE, WI 54751

07/01/2019 06/30/2021RIVERVIEW MIDDLE SCHOOL, 135 WEST RIVER AVE, BARRON, WI 54812

07/01/2019 06/30/2021ROSELAWN ELEMENTARY SCHOOL, 1201 6TH ST, CHETEK, WI 54728

07/01/2019 06/30/2021SAM DAVEY ELEMENTARY SCHOOL, 3000 STARR AVE, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021SHELL LAKE ELEMENTARY, 31 3RD ST, SHELL LAKE, WI 54871

07/01/2019 06/30/2021SHELL LAKE MIDDLE AND HIGH SCHOOL, 271 HWY 63, SHELL LAKE, WI 54871

07/01/2019 06/30/2021SHERMAN ELEMENTARY SCHOOL, 3110 W VINE ST, EAU CLAIRE, WI 54703

07/01/2019 06/30/2021STANLEY-BOYD ELEMENTARY, MIDDLE AND HIGH SCHOOL, 507 EAST 1ST AVENUE, STANLEY, WI 54768

07/01/2019 06/30/2021TAINTER ELEMENTARY SCHOOL, 2201 CARRIE AVENUE, RICE LAKE, WI 54868

07/01/2019 06/30/2021THORP ELEMENTARY, MIDDLE AND HIGH SCHOOL, 605 SOUTH CLARK STREET, THORP, WI 54771

07/01/2019 06/30/2021WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVE, BARRON, WI 54812

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Mental Health Program Directory By County, City, and Provider Name

1562MARRIAGE AND FAMILY HEALTH SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201809/01/1983

(715) 832-0771

(715) [email protected] SCHULZ-JOHNSTON

County: Eau ClaireEAU CLAIRE, WI 547012925 MONDOVI ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020MARRIAGE & FAMILY HEALTH SERVICES, 132 W COLUMBIA STREET, CHIPPEWA FALLS, WI 547291

11/01/2018 04/30/2020MARRIAGE AND FAMILY HEALTH SERVICES, LTD, 403 3RD AVE W, DURAND, WI 547361

05/01/2018 04/30/2020MARRIAGE & FAMILY HEALTH SERVICES, 105 WEST AVENUE, RICE LAKE, WI 548682

05/01/2018 04/30/2020MARRIAGE & FAMILY HEALTH SERVICES, 2910 ENLOE ST, HUDSON, WI 540162

05/01/2018 04/30/2020BLOOMER ELEMENTARY SCHOOL, 401 8TH AVENUE, BLOOMER, WI 547243

05/01/2018 04/30/2020BLOOMER HIGH SCHOOL, 1310 17TH AVENUE, BLOOMER, WI 547243

05/01/2018 04/30/2020BLOOMER MIDDLE SCHOOL, 600 JACKSON ST, BLOOMER, WI 547243

05/01/2018 04/30/2020FALL CREEK ELEM, MIDDLE & HIGH SCHOOL, 336 E. HOOVER AVE., FALL CREEK, WI 547423

05/01/2018 04/30/2020MFHS AUGUSTA ELEM. MIDDLE AND HIGH SCHOOL, E19320 BARTIG ROAD, AUGUSTA, WI 547223

05/01/2018 04/30/2020MFHS- BARRON MIDDLE & HIGH SCHOOL, 1050 E WOODLAND AVE, BARRON, WI 548123

05/01/2018 04/30/2020MFHS- DELONG MIDDLE SCHOOL, 2000 VINE ST, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- ELEVA STRUM CENTRAL MIDDLE & HIGH SCHOOL, W 23597 US HWY 10, STRUM, WI 547703

05/01/2018 04/30/2020MFHS- FLYNN ELEMENTARY, 1430 LEE ST, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- HALMSTAD ELEMENTARY, 565 E SOUTH AVE, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS- LAKESHORE ELEMENTARY, 711 LAKE STREET, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- LONGFELLOW ELEMENTARY, 500 BALCOM ST, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- MEMORIAL HIGH SCHOOL, 2225 KEITH ST, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS- NORHTSTAR MIDDLE SCHOOL, 2711 ABBE HILL DR, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- NORTH HIGH SCHOOL, 1801 PIEDMONT RD, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS- NORTHWOODS ELEMENTARY, 3600 NORTHWOODS, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS- OAK LAWN ELEMENTARY SCHOOL, 500 21ST STREET SOUTH, MENOMONIE, WI 547513

05/01/2018 04/30/2020MFHS- PUTNAM HEIGHTS ELEMENTARY, 633 W MACARTHUR AVE, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS- SOUTH MIDDLE SCHOOL, 2115 MITSCHER AVE, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS-CAMERON ELEMENTARY SCHOOL, 600 WISCONSIN AVENUE, CAMERON, WI 548223

05/01/2018 04/30/2020MFHS-CAMERON HIGH SCHOOL, 750 SOUTH 1ST STREET, CAMERON, WI 548223

05/01/2018 04/30/2020MFHS-CAMERON MIDDLE SCHOOL, 700 SOUTH 1ST STREET, CAMERON, WI 548223

05/01/2018 04/30/2020MFHS-CHIPPEWA FALLS HIGH SCHOOL, 735 TERRILL STREET, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-CHIPPEWA VALLEY HIGH SCHOOL, 2820 E PARK AVENUE, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-CUMBERLAND ELEMENTARY SCHOOL, 1530 2ND AVENUE, CUMBERLAND, WI 548293

05/01/2018 04/30/2020MFHS-CUMBERLAND HIGH SCHOOL, 1000 8TH AVENUE, CUMBERLAND, WI 548293

05/01/2018 04/30/2020MFHS-CUMBERLAND MIDDLE SCHOOL, 980 8TH AVENUE, CUMBERLAND, WI 548293

05/01/2018 04/30/2020MFHS-DURAND MIDDLE & HIGH SCHOOL, 604 - 7TH AVE. EAST, PO BOX 190, DURAND, WI 547363

05/01/2018 04/30/2020MFHS-ELK MOUND HIGH SCHOOL, 405 UNIVERSITY ST., ELK MOUND, WI 547393

05/01/2018 04/30/2020MFHS-ELK MOUND MIDDLE SCHOOL, 302 UNIVERSITY ST., ELK MOUND, WI 547393

05/01/2018 04/30/2020MFHS-ELLSWORTH HIGH SCHOOL, 323 HILLCREST STREET, ELLSWORTH, WI 540113

05/01/2018 04/30/2020MFHS-ELLSWORTH MIDDLE SCHOOL, 312 WEST PANTHER DRIVE, ELLSWORTH, WI 540113

05/01/2018 04/30/2020MFHS-HAUGEN ELEMENTARY, 615 W 5TH STREET, HAUGEN, WI 548413

05/01/2018 04/30/2020MFHS-HILCREST ELEMENTARY, 1200 MILES STREET, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-HILLCREST ELEMENTARY, 350 SOUTH GRANT STREET, ELLSWORTH, WI 540113

05/01/2018 04/30/2020MFHS-HILLTOP ELEMENTARY, 202 CAMERON ROAD, RICE LAKE, WI 548683

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05/01/2018 04/30/2020MFHS-JIM FALLS ELEMENTARY, 13643 - 198TH STREET, JIM FALLS, WI 547483

05/01/2018 04/30/2020MFHS-MEADOWVIEW ELEMENTARY, 4714 FAIRFAX STREET, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS-MENOMONIE MIDDLE SCHOOL, 920 21ST STREET SE, MENOMONIE, WI 547513

05/01/2018 04/30/2020MFHS-MEYER MIDDLE SCHOOL, 230 N. 9TH ST., RIVER FALLS, WI 540223

05/01/2018 04/30/2020MFHS-MOUND VIEW ELEMENTARY SCHOOL, 455 UNIVERSITY ST., ELK MOUND, WI 547393

05/01/2018 04/30/2020MFHS-PARKVIEW ELEMENTARY, 501 JEFFERSON AVENUE, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-PRAIRIE VIEW ELEMENTARY, W 7375 - 170TH AVENUE, HAGER CITY, WI 540143

05/01/2018 04/30/2020MFHS-RICE LAKE HIGH SCHOOL, 30 SOUTH WISCONSIN, RICE LAKE, WI 548683

05/01/2018 04/30/2020MFHS-RICE LAKE MIDDLE SCHOOL, 204 CAMERON ROAD, RICE LAKE, WI 548683

05/01/2018 04/30/2020MFHS-RIVER FALLS HIGH SCHOOL, 818 CEMETERY RD., RIVER FALLS, WI 540223

05/01/2018 04/30/2020MFHS-ROBBINS ELEMENTARY, 3832 E. HAMILTON AVENUE, EAU CLAIRE, WI 547013

05/01/2018 04/30/2020MFHS-ROCKY BRANCH ELEMENTARY SCHOOL, 1415 S. BARTOSH LN., RIVER FALLS, WI 540223

05/01/2018 04/30/2020MFHS-SHERMAN ELEMENTARY, 3110 VINE STREET, EAU CLAIRE, WI 547033

05/01/2018 04/30/2020MFHS-SOUTHVIEW ELEMENTARY, 615 A STREET, CHIPPEWA FALLS, WI 547293

05/01/2018 04/30/2020MFHS-WAKANDA ELEMENTARY SCHOOL, 1801 WAKANDA STREET NE, MENOMONIE, WI 547513

05/01/2018 04/30/2020MFHS-WOODLAND ELM SCHOOL, 808 E WOODLAND AVE, BARRON, WI 548123

05/01/2018 04/30/2020MHFS-BOYCEVILLE MIDDLE & HIGH SCHOOL, 1003 EAST STREET, BOYCEVILLE, WI 547253

05/01/2018 04/30/2020TIFFANY CREEK ELEMENTARY SCHOOL, 161 EAST STREET, BOYCEVILLE, WI 547253

05/01/2018 04/30/2020WINTER SCHOOL DISTRICT, 6585 W. GROVE STREET, WINTER, WI 548963

1511MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201806/01/1981

(715) 838-3649

(715) [email protected] PHILLIPS

County: Eau ClaireEAU CLAIRE, WI 547031221 WHIPPLE STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 12/01/2018 11/30/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2018 11/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1512MAYO CLINIC HEALTH SYSTEM EAU CLAIRE

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201910/01/1981

(715) 838-3032

(715) 838-5369

EVE FISCHER

County: Eau ClaireEAU CLAIRE, WI 547031221 WHIPPLE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020MAYO CLINIC HEALTH SYSTEMS - CHIPPEWA FALLS OFFICE, 611 1ST AVENUE, CHIPPEWA FALLS,

WI 547291

01/01/2019 12/31/2020MAYO CLINIC HEALTH SYSTEM NORTHLAND, 331 S MAIN STREET, RICE LAKE, WI 548682

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3147MOSAIC COUNSELING GROUP LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/16/2016

(715) 514-0272

(715) 514-0455info@mosaicprofessionalcounselingKELLY CARPENTER

County: Eau ClaireEAU CLAIRE, WI 547013430 OAKWOOD MALL DRIVE STE 200

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2947SACRED HEART BEHAVIORAL HEALTH CLINIC DBA PREVEA HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/31/2011

(715) 717-5898

(715) [email protected] SIMONSON

County: Eau ClaireEAU CLAIRE, WI 547012119 HEIGHTS DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2019 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 10/11/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/11/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/11/2019 09/30/2020PREVEA CANCER CTR AT HSHS SACRED HEART HOSP, 900 W CLAIREMONT AVE, EAU CLAIRE, WI

547011

10/11/2019 09/30/2020PREVEA HEALTH FAMILY MEDICINE, 617 W CLAIREMONT AVE, EAU CLAIRE, WI 547011

10/01/2018 09/30/2020CHIPPEWA FALLS CLINIC, 2449 COUNTY HWY I, CHIPPEWA FALLS, WI 547292

10/11/2019 09/30/2020PREVEA ALTOONA MEDICAL OFFICE BLDG, 3119 WOODMAN DR, ALTOONA, WI 547202

01/01/2019 09/30/2020PREVEA LADYSMITH HEALTH CENTER, 1101 W LAKE AVE, LADYSMITH, WI 548482

10/01/2018 09/30/2020RICE LAKE CLINIC, 1051 WEST AVENUE, RICE LAKE, WI 548682

10/11/2019 09/30/2020LAKE HOLCOMBE ELEM/HIGH SCHOOL, 27331 262ND AVE, HOLCOMBE, WI 547453

Setting Begin/End DatesNon-Certified School Setting(s)10/01/2018 09/30/2020CHIPPEWA FALLS HIGH, 735 TERRIL ST, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020CHIPPEWA FALLS MIDDLE, 750 TROPICANA BLVD, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020CHIPPEWA VALLEY HIGH, 2820 E PARK AVE, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020CHIPPEWA VALLEY MONTESSORI, 400 CAMERON ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020DELONG MIDDLE, 2000 VINE ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020ECASD EARLY LEARNING PROGRAM, 3031 EPIPHANY LANE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020FLYNN ELEMENTARY, 1430 LEE ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020HALMSTAD ELEMENTARY, 565 E SOUTH AVE, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020HILLCREST ELEMENTARY, 1200 MILES ST, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020JIM FALLS ELEMENTARY, 13643 198TH ST, JIM FALLS, WI 54748

10/01/2018 09/30/2020LAKESHORE ELEMENTARY, 711 LAKE ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020LOCUST LANE ELEMENTARY, 3245 LOCUST LANE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020LONGFELLOW ELEMENTARY, 500 BALCOM, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020MANZ ELEMENTARY, 1000 E FILMORE AVE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020MCKINLEY CHARTER, 1266 MCKINLEY RD, EAU CLAIRE, WI 54703

10/01/2018 09/30/2020MEADOWVIEW ELEMENTARY, 4714 FAIRFAX, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020MEMORIAL HIGH, 2225 KEITH ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020NORTH HIGH, 1801 PIEDMONT RD, EAU CLAIRE, WI 54703

10/01/2018 09/30/2020NORTHSTAR MIDDLE, 2711 ABBE HILL DR, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020NORTHWOODS ELEMENTARY, 3600 NORTHWOODS LANE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020PARKVIEW ELEMENTARY, 501 JEFFERSON AVE, CHIPPEWA FALLS, WI 54729

10/01/2018 09/30/2020PUTNAM HEIGHTS ELEMENTARY, 633 W MACARTHUR AVE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020ROBBINS ELEMENTARY, 3832 E HAMILTON AVE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020ROOSEVELT ELEMENTARY, 3010 8TH ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020SAM DAVEY ELEMENTARY, 3000 STARR AVE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020SHERMAN ELEMENTARY, 3110 W VINE ST, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020SOUTH MIDDLE, 2115 MITSCHER AVE, EAU CLAIRE, WI 54701

10/01/2018 09/30/2020SOUTHVIEW ELEMENTARY, 615 A STREET, CHIPPEWA FALLS, WI 54729

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Mental Health Program Directory By County, City, and Provider Name

10/01/2018 09/30/2020STILLSON, 17250 CTY HWY J, CHIPPEWA FALLS, WI 54729

2029SACRED HEART HOSPITAL

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201902/01/1982

(715) 717-4996

(715) [email protected] SIMONSON

County: Eau ClaireEAU CLAIRE, WI 54701900 W. CLAIREMONT AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 01/01/2019 12/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

1408SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201808/01/1990

(715) 834-3174

(715) [email protected] BJERKE

County: Eau ClaireEAU CLAIRE, WI 547012005 HIGHLAND AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 1443 B EAST DIVISION AVE, BARRON,

WI 548122

09/01/2018 08/31/2020SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 420 S BARSTOW STREET, #3, EAU CLAIRE, WI 54701

2

2440WISCONSIN EARLY AUTISM PROJECT, INC.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201705/12/2003

(715) 833-1666

(715) [email protected] SEDLACEK

County: Eau ClaireEAU CLAIRE, WI 547012125 HEIGHTS DRIVE SUITE 2F

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

FOND DU LACFOND DU LAC

2226AGNESIAN HEALTHCARE DBA DOLL AND ASSOCIATES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/05/2000

(920) 907-8209

(920) [email protected] ROGERS-DOLL

County: Fond Du LacFOND DU LAC, WI 5493540 CAMELOT DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021TREFFERT CENTER, 371 E 1ST STREET, FOND DU LAC, WI 549352

2680FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201907/18/2006

(920) 929-3129

(920) [email protected] FOUST

County: Fond Du LacFOND DU LAC, WI 54935459 E FIRST STREET

CCS Affiliaton: 01/01/2018Begin: End: Lead:Northeastern Regional CCS Consortium V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

1350FOND DU LAC COUNTY DEPT OF COMMUNITY PROGRAMS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201807/01/1978

(920) 929-3129

(920) [email protected] VANEVENHOVEN

County: Fond Du LacFOND DU LAC, WI 54935459 E FIRST STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 03/01/2018 02/29/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-PREVENTION DHS 75.04 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2018 02/29/2020

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1847ST AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201805/01/1980

(920) 926-8933

(920) [email protected] DOLL

County: Fond Du LacFOND DU LAC, WI 54935430 EAST DIVISION STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2018 12/31/2019

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2018 12/31/2019

MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019AGNESIAN AT MARR, 21 S MARR STREET, FOND DU LAC, WI 549352

01/01/2018 12/31/2019ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI 549712

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Mental Health Program Directory By County, City, and Provider Name

FORESTCRANDON

1351FOREST COUNTY POTAWATOMI BEHAVIORAL HEALTH DEPARTMENT

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/1994

(715) 478-4493

(715) [email protected] SHINE

County: ForestCRANDON, WI 545208201 MISH KO SWEN DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

GRANTLANCASTER

3265EMPOWERMENT COUNSELING, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202011/07/201911/07/2019

(605) 535-6862

(608) 723-4433samantha@empowermentcounselinSAMANTHA LEIBFRIED

County: GrantLANCASTER, WI 53813702 S MADISON ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/07/2019 11/30/2020

Services

NO BRANCH LOCATIONS

1943UNIFIED COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201910/01/1975

(608) 723-4417

(608) [email protected] KNAPP

County: GrantLANCASTER, WI 53813200 W ALONA LANE

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021UNIFIED COMMUNITY SERVICES, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 535332

1941UNIFIED COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201807/01/1994

(608) 723-4417

(608) [email protected] KNAPP

County: GrantLANCASTER, WI 53813200 W. ALONA LANE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2018 09/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 06/24/2019

11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020UNIFIED COMMUNITY SERVICES - CSP, 1122 PROFESSIONAL DRIVE, DODGEVILLE, WI 535331

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Mental Health Program Directory By County, City, and Provider Name

PLATTEVILLE

1738PLATTEVILLE FAMILY RESOURCE CENTER, INC.

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201809/08/1995

(608) 348-4191

(608) [email protected] K. WRUBLE

County: GrantPLATTEVILLE, WI 538181075 N ELM STREET, #120

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020PLATTEVILLE FAMILY RESOURCE CENTER - MOUNT HOREB O, 1406 SPRINGDALE ST. SUITE 102,

MOUNT HOREB, WI 535721

10/01/2018 09/30/2020PLATTEVILLE FAMILY RESOURCE CENTER, INC, 219 W MAPLE STREET, LANCASTER, WI 538131

10/01/2018 09/30/2020PLATTEVILLE FAMILY RESOURCE CENTER INC., 218 E SWAYNE ST, STE 200, DODGEVILLE, WI 53533

2

Setting Begin/End DatesNon-Certified School Setting(s)01/15/2019 09/30/2020NEAL WILKINS EARLY LEARNING SCHOOL, 425 BROADWAY ST, PLATTEVILLE, WI 53818

01/15/2019 09/30/2020PLATTEVILLE HIGH SCHOOL, 710 E MADISON ST, PLATTEVILLE, WI 53818

01/15/2019 09/30/2020PLATTEVILLE MIDDLE SCHOOL, 40 E MADISON ST, PLATTEVILLE, WI 53818

01/15/2019 09/30/2020POTOSI SCHOOLS, 128 HIGHWAY 61 N, POTOSI, WI 53820

01/15/2019 09/30/2020WESTVIEW ELEMENTARY SCHOOL, 1201 CAMP ST, PLATTEVILLE, WI 53818

2197SOUTHWEST BEHAVIORAL SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2000

(608) 342-3026

(608) [email protected] HEBGEN

County: GrantPLATTEVILLE, WI 538181185 NORTH ELM STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

3130SOUTHWEST BEHAVIORAL SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201804/25/2016

(608) 342-3025

(608) [email protected] MILLER KASS

County: GrantPLATTEVILLE, WI 538181450 EAST SIDE ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020BLOOMFIELD MANOR, 3151 COUNTY RD CH, DODGEVILLE, WI 535331

03/01/2018 02/29/2020BOSCOBEL CARE AND REHAB, 207 PARKER ST, BOSCOBEL, WI 538051

03/01/2018 02/29/2020DIVINE CARE AND REHAB, 1850 11TH STREET, FENNIMORE, WI 538091

03/01/2018 02/29/2020EDENBROOK OF PLATTEVILLE, 1300 NORTH WATER ST, PLATTEVILLE, WI 538181

03/01/2018 02/29/2020LANCASTERHEALTH SERVICES, 1350 S MADISON ST, LANCASTER, WI 538131

03/01/2018 02/29/2020MINERAL POINT HEALTH SERVICES, 109 NORTH IOWA ST, MINERAL POINT, WI 535651

03/01/2018 02/29/2020ORCHARD MANOR, 8800 HWY 61, LANCASTER, WI 538131

03/01/2018 02/29/2020PRAIRIE MAISON, 700 S. FREEMONT ST, PRAIRIE DU CHIEN, WI 538211

03/01/2018 02/29/2020SOUTHWEST HEALTH CTR EPIONE PAVILLION, 808 S WASHINGTON ST, CUBA CITY, WI 538071

03/01/2018 02/29/2020UPLAND HILLS HEALTH & REHAB CENTER, 800 COMPASSION WAY, DODGEVILLE, WI 535331

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Mental Health Program Directory By County, City, and Provider Name

GREENMONROE

1388GREEN COUNTY HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201810/01/1975

(608) 328-2139

(608) [email protected] MILES

County: GreenMONROE, WI 53566N3152 STATE ROAD 81

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2018 12/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

CSAS-PREVENTION DHS 75.04 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019GREEN COUNTY ADULT DRUG COURT, 2841 6TH STREET, MONROE, WI 535662

2328GREEN COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2000

(608) 328-9480

(608) [email protected] WILLIAMS

County: GreenMONROE, WI 53566N 3152 STATE ROAD 81

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

3085GREEN/LAFAYETTE REGIONAL COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/2015

(608) 325-2139

(608) [email protected] BOWYER

County: GreenMONROE, WI 53566N3152 STATE RD 81

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/27/2019 05/31/2021LAFAYETTE COUNTY HUMAN SERVICES, 15701 CO RD K STE 3, DARLINGTON, WI 535302

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Mental Health Program Directory By County, City, and Provider Name

1915MONROE CLINIC BEHAVIORAL HEALTH

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201905/01/1981

(608) 324-2102

(608) [email protected] GALLAGHER

County: GreenMONROE, WI 53566515 - 22ND AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021MONROE CLINIC - BRODHEAD, 1ST CENTER AVE, BRODHEAD, WI 535201

08/01/2019 07/31/2021MONROE CLINIC - FREEPORT BRANCH, 1301 KIWANIS DRIVE, FREEPORT, IL 610321

08/01/2019 07/31/2021MONROE CLINIC - NEW GLARUS BRANCH, 1800 - 2ND ST, NEW GLARUS, WI 535741

Setting Begin/End DatesNon-Certified School Setting(s)10/15/2019 07/31/2021ABRAHAM LINCOLN ELEMENTARY, 2625 14TH AVE, MONROE, WI 53566

10/15/2019 07/31/2021MONROE HIGH SCHOOL, 1600 26TH ST, MONROE, WI 53566

10/15/2019 07/31/2021MONROE MIDDLE SCHOOL, 1510 13TH ST, MONROE, WI 53566

10/15/2019 07/31/2021MONTICELLO SCHOOL, 334 SOUTH MAIN ST, NEW GLARUS, WI 53574

10/15/2019 07/31/2021NEW GLARUS ELEMENTARY, 1420 2ND ST, NEW GLARUS, WI 53574

10/15/2019 07/31/2021NEW GLARUS HIGH SCHOOL, 1701 2ND ST, NEW GLARUS, WI 53574

10/15/2019 07/31/2021NORTHSIDE ELEMENTARY, 3005 8 1/2 ST, MONROE, WI 53566

10/15/2019 07/31/2021PARKSIDE ELEMENTARY, 920 4TH ST, MONROE, WI 53566

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Mental Health Program Directory By County, City, and Provider Name

GREEN LAKEGREEN LAKE

1389GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201804/01/1977

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2018 10/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

CSAS-PREVENTION DHS 75.04 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2018 10/31/2020

Services

11/01/2018 10/31/2020BERLIN MIDDLE SCHOOL, 242 MEMORIAL DRIVE, BERLIN, WI 54923

11/01/2018 10/31/2020MARKESAN HIGH SCHOOL, 100 E VISTA BLVD, MARKESAN, WI 53946

2265GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2000

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

2599GREEN LAKE COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201908/22/2005

(920) 294-4139

(920) [email protected] JEROME

County: Green LakeGREEN LAKE, WI 54941571 COUNTY ROAD A

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

IRONHURLEY

2347IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2002

(715) 561-2128

(715) [email protected] BUCKNELL

County: IronHURLEY, WI 54534300 TACONITE STREET, #201

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021HURLEY SCHOOL, 5503 W RANGE VIEW DR, HURLEY, WI 545343

2745IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES COMM SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2007

(715) 561-2128

(715) [email protected] BUCKNELL

County: IronHURLEY, WI 54534300 TACONITE STREET, #201

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2019 02/28/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 03/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

JACKSONBLACK RIVER FALLS

3278FAMILY & CHILDREN'S CENTER COMMUNITY SUPPORT PROGRAM - JACKSON COUNTY

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/202001/01/2020

(608) 396-6025

(608) [email protected] BAILEY

County: JacksonBLACK RIVER FALLS, WI 54615421 CTY RD R

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2020

Services

NO BRANCH LOCATIONS

1413HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201805/01/1992

(715) 284-3434

(715) [email protected] SUQUET

County: JacksonBLACK RIVER FALLS, WI 54615N 6250 LUMBERJACK GUY ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020MADISON BRANCH OFFICE, 4724 TRADE WINDS PARKWAY, MADISON, WI 537181

11/01/2018 10/31/2020NEKOOSA HEALTH OFFICE, 1021 COUNTY HWY G, NEKOOSA, WI 544572

11/01/2018 10/31/2020THREE RIVERS HOUSE, 724 MAIN STREET, LA CROSSE, WI 546012

11/01/2018 10/31/2020TOMAH HEALTH OFFICE, 430 JULIE ST, STE 2, TOMAH, WI 546602

11/01/2018 10/31/2020WELLNESS CENTER HEALTH OFFICE, S2845 WHITE EAGLE ROAD, BARABOO, WI 539132

11/01/2018 10/31/2020WITTENBERG HEALTH OFFICE, W17634 RADKE RD, WITTENBERG, WI 544992

2957JACKSON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202001/30/201901/01/2012

(715) 284-7713

(715) [email protected] HOVELL

County: JacksonBLACK RIVER FALLS, WI 54615421 COUNTY RD R

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/30/2019 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/30/2019 08/31/2020

Services

NO BRANCH LOCATIONS

2901JACKSON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202001/30/201905/01/2010

(715) 284-7713

(715) [email protected] HOVELL

County: JacksonBLACK RIVER FALLS, WI 54615421 COUNTY RD R

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/30/2019 04/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1473KROHN CLINIC, LTD.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201902/01/1988

(715) 284-0475

(715) [email protected] GILBERTSON

County: JacksonBLACK RIVER FALLS, WI 54615610 W ADAMS STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

2655NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - BLACK RIVER FALLS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/2006

(888) 932-5853

(715) [email protected] MAURER

County: JacksonBLACK RIVER FALLS, WI 54615N6643 COUNTY RD A

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2019 01/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

02/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

JEFFERSONFORT ATKINSON

1309FORT HEALTH CARE BEHAVIORAL HEALTH

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201912/01/1991

(920) 563-4228

(920) [email protected] LESLIE

County: JeffersonFORT ATKINSON, WI 53538500 MCMILLEN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021FORT HEALTHCARE - CAMBRIDGE CLINIC, 704 KATIE COURT, CAMBRIDGE, WI 535231

02/01/2019 01/31/2021FORT HEALTHCARE - JEFFERSON CLINIC, 840 W RACINE, JEFFERSON, WI 535491

02/01/2019 01/31/2021FORT HEALTHCARE - LAKE MILLS CLINIC, 200 E TYRANENA PK ROAD, LAKE MILLS, WI 535511

02/01/2019 01/31/2021FORT HEALTHCARE INTEGRATED FAMILY CARE, 1520 MADISON AVE, FORT ATKINSON, WI 535382

12/17/2019 01/31/2021CAMBRIDGE HIGH SCHOOL, 403 BLUE JAY WAY, CAMBRIDGE, WI 535233

12/17/2019 01/31/2021FORT ATKINSON MIDDLE SCHOOL, 310 4TH ST E, FORT ATKINSON, WI 535383

12/17/2019 01/31/2021LAKEVIEW ELEMENTARY SCHOOL, W8363 R&W TOWNLINE RD, WHITEWATER, WI 531903

12/17/2019 01/31/2021LINCOLN ELEMENTARY SCHOOL, 242 SO PRINCE ST, WHITEWATER, WI 531903

12/17/2019 01/31/2021NIKOLAY MIDDLE SCHOOL, 211 SOUTH ST, CAMBRIDGE, WI 535233

12/17/2019 01/31/2021WASHINGTON ELEMENTARY SCHOOL, 506 E MAIN ST, WHITEWATER, WI 531903

02/01/2019 01/31/2021WHITEWATER HIGH SCHOOL, 534 S ELIZABETH ST, WHITEWATER, WI 531903

02/01/2019 01/31/2021WHITEWATER MIDDLE SCHOOL, 401 S ELIZABETH ST, WHITEWATER, WI 531903

JEFFERSON

1449JEFFERSON COUNTY HUMAN SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201910/01/1975

(920) 674-6113

(920) [email protected] CAULEY

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

2221JEFFERSON COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/2000

(920) 674-7409

(920) [email protected] THORMAN

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2643JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201902/15/2006

(920) 674-2359

(920) [email protected] CONGDON

County: JeffersonJEFFERSON, WI 535491541 ANNEX ROAD

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

WATERTOWN

1326FAMILY RESOURCES ASSOCIATES, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/01/1993

(920) 261-8801

(920) [email protected] KUEFFER

County: JeffersonWATERTOWN, WI 530941315 W MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020FAMILY RESOURCES ASSOCIATES INC, 248 S. WISCONSIN DRIVE, JEFFERSON, WI 535492

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Mental Health Program Directory By County, City, and Provider Name

JUNEAUMAUSTON

1453JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/1988

(608) 847-9421

(608) [email protected] GLYNN

County: JuneauMAUSTON, WI 53948200 HICKORY STREET

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

3000JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2013

(608) 847-9421

(608) [email protected] MOORE

County: JuneauMAUSTON, WI 53948200 HICKORY STREET

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

1452JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201901/01/1989

(608) 847-9421

(608) [email protected] JO ONSAGER

County: JuneauMAUSTON, WI 53948200 HICKORY STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3173PINE VALLEY INTEGRATED SERVICES LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/18/201807/14/2017

(608) 350-1288

(608) [email protected] BRONECKI

County: JuneauMAUSTON, WI 53948124 GRAYSIDE AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/18/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/18/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/18/2018 05/31/2020NEW LISBON FAMILY MEDICAL CENTER, 901 BRIDGE ST, NEW LISBON, WI 539501

06/18/2018 05/31/2020MILE BLUFF CLINIC, 1040 DIVISION STREET, MAUSTON, WI 539482

06/18/2018 05/31/2020ADAMS FRIENDSHIP ELEMENTARY SCHOOL, 500 N PIERCE ST, ADAMS, WI 539103

06/18/2018 05/31/2020ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 539103

06/18/2018 05/31/2020ADAMS FRIENDSHIP MIDDLE SCHOOL, 420 N MAIN ST, ADAMS, WI 539103

11/19/2018 05/31/2020CAMP DOUGLAS ELEMENTARY, 81 JUNCTION ST, CAMP DOUGLAS, WI 546183

09/17/2018 05/31/2020CESA JUNEAU CO-ADOLESCENT, 11003 17TH AVE, NECEDAH, WI 546463

09/13/2018 05/31/2020GRAND MARSH ELEMENTARY, 620 HIGHWAY E, GRAND MARSH, WI 539363

09/03/2019 05/31/2020GRAYSIDE ELEMENTARY SCHOOL, 510 GRAYSIDE AVE, MAUSTON, WI 539483

09/03/2019 05/31/2020ILEAD CHARTER SCHOOL, 800 GRAYSIDE, MAUSTON, WI 539483

11/19/2018 05/31/2020LAGRANGE ELEMENTARY, 600 STRAW ST, TOMAH, WI 546603

11/19/2018 05/31/2020LEMONWEIR ELEMENTARY, 711 N GLENDALE AVE, TOMAH, WI 546603

09/03/2019 05/31/2020LYNDON STATION SCHOOL, 201 HOEHN DRIVE, LYNDON STATION, WI 539443

09/03/2019 05/31/2020MAUSTON HIGH SCHOOL, 800 GRAYSIDE AVE, MAUSTON, WI 539483

11/19/2018 05/31/2020MILLER ELEMENTARY, 813 OAK AVE, TOMAH, WI 546603

09/03/2019 05/31/2020NECEDAH ELEMENTARY SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 546463

09/03/2019 05/31/2020NECEDAH MIDDLE/HIGH SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 546463

11/19/2018 05/31/2020OAKDALE ELEMENTARY, 217 S OAKWOOD ST, TOMAH, WI 546603

09/03/2019 05/31/2020OLSON MIDDLE SCHOOL, 508 GRAYSIDE AVE, MAUSTON, WI 539483

11/19/2018 05/31/2020ROBERT KUPPER LEARNING CENTER, 1310 TOWNLINE RD, TOMAH, WI 546603

11/19/2018 05/31/2020TOMAH AREA HIGH SCHOOL, 901 LINCOLN AVE, TOMAH, WI 546603

11/19/2018 05/31/2020TOMAH AREA MIDDLE SCHOOL, 612 HOLLISTER AVE, TOMAH, WI 546603

11/19/2018 05/31/2020TOMAH AREA MONTESSORI, 1720 ACADEMY AVE, TOMAH, WI 546603

11/19/2018 05/31/2020TOMAH AREA SCHOOL DISTRICT, 129 W CLIFTON ST, TOMAH, WI 546603

11/19/2018 05/31/2020WARRENS ELEMENTARY, 409 MAIN ST, WARRENS, WI 546663

09/03/2019 05/31/2020WESTSIDE ELEMENTARY, 708 LOOMIS DRIVE, MAUSTON, WI 539483

11/19/2018 05/31/2020WYEVILLE ELEMENTARY, 225 W TOMAH RD, WYEVILLE, WI 546603

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Mental Health Program Directory By County, City, and Provider Name

KENOSHAKENOSHA

1083AALTO ENHANCEMENT CENTER, SC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201904/09/1991

(262) 654-9379

(262) [email protected] A. AALTO

County: KenoshaKENOSHA, WI 531428503 - 75TH STREET, #A

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/10/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

2218AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/24/1998

(414) 422-2188

(414) [email protected] VALENTIN

County: KenoshaKENOSHA, WI 5314212225 - 71ST STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021AURORA BEHAVIORAL HEALTH SVS-KENOSHA NORTH, 6811 118TH PL., KENOSHA, WI 531401

10/01/2019 09/30/2021AURORA BEHAVIORAL HEALTH SVS-RACINE WEST, 8348 WASHINGTON AVE., RACINE, WI 534051

1193CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/1993

(262) 652-7728

(262) [email protected] HULETZ

County: KenoshaKENOSHA, WI 531426809 122ND AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021WALWORTH COUNTY CHILD ADVOCACY CENTER, W4063 HWY, NN, ELKHORN, WI 531212

1440INTERCONNECTIONS, S.C.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201908/01/1981

(262) 654-7818

(262) [email protected] NICHOLS

County: KenoshaKENOSHA, WI 53140920 - 60TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3081KENOSHA COMMUNITY HEALTH CENTER, INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201905/01/2015

(262) 653-2218

(262) [email protected] MARSHALL

County: KenoshaKENOSHA, WI 531404536 22ND AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/29/2019 05/31/2021KENOSHA COMMUNITY HEALTH CENTER - SILVER LAKE, 903 S 2ND STREET, SILVER LAKE, WI

531701

06/01/2019 05/31/2021KENOSHA COMMUNITY HEALTH CENTER - 14TH AVE CLINIC, 6226 14TH AVENUE, KENOSHA, WI 53143

2

2589KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2005

(262) 697-4655

(262) [email protected] HANKS

County: KenoshaKENOSHA, WI 531438600 SHERIDAN RD #100

CCS Affiliaton: 12/01/2014Begin: End: Lead:Kenosha Racine Regional Consortium (KRRC)

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 04/30/2021KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), 5407 8TH AVENUE, KENOSHA, WI 531402

1460KENOSHA COUNTY DEPT OF HUMAN SERVICES/KENOSHA HUMAN DEVELOPMENT SERVICES INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/01/1977

(262) 653-2080

(262) [email protected] M FIELD

County: KenoshaKENOSHA, WI 531405407 8TH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

2941KENOSHA HUMAN DEVELOPMENT SERVICES, INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/01/2012

(262) 842-0539

(262) [email protected] MARTIN

County: KenoshaKENOSHA, WI 53140712 55TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 10/19/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2897KENOSHA HUMAN DEVELOPMENT SERVICES, INC COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/01/2010

(262) 653-2080

(262) [email protected] THORNTON

County: KenoshaKENOSHA, WI 531405407 8TH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

2613MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/14/2005

(262) 605-1404

(262) [email protected] MOORE

County: KenoshaKENOSHA, WI 531436530 SHERIDAN ROAD, #3

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021MOORE & ASSOCIATES, INC, 220 S COUNTY ROAD H, UNIT A, ELKHORN, WI 531211

10/01/2019 09/30/2021MOORE & ASSOCIATES, INC, 1656 WASHINGTON AVE, RACINE, WI 534042

2028OAKWOOD CLINICAL ASSOCIATES, LTD.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/25/1991

(262) 652-2931

(262) [email protected] ANDERSON

County: KenoshaKENOSHA, WI 531424109 67TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020OAKWOOD CLINICAL ASSOCIATES LTD, 24804 75TH STREET, PADDOCK LAKE, WI 531682

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Mental Health Program Directory By County, City, and Provider Name

1749PROFESSIONAL SERVICES GROUP, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201806/01/1983

(262) 652-2408

(262) [email protected] FEATHERSTONE

County: KenoshaKENOSHA, WI 531432108 63RD STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 614 N 3RD STREET, WAUSAU, WI 544031

04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 724 ELM STREET, WEST BEND, WI 530951

06/25/2019 03/31/2020PSG - BOYS & GIRLS CLUB OFFICE KENOSHA, 1330 52ND ST, KENOSHA, WI 531401

03/29/2019 03/31/2020PSG - BOYS & GIRLS CLUB OFFICE, 925 N SILVERBROOK DR, WEST BEND, WI 530901

03/29/2019 03/31/2020PSG - BOYS & GIRLS CLUB OFFICE, N165 W20330 HICKORY LN, JACKSON, WI 530371

09/12/2019 03/31/2020PSG - THE SHARING CENTER, 25700 WLMOT RD HWY C, TREVOR, WI 531791

09/04/2019 03/31/2020PROFESSIONAL SERVICES GROUP, 1205 S 70TH STREET #301, MILWAUKEE, WI 532142

03/05/2019 03/31/2020PROFESSIONAL SERVICES GROUP, 1905 CENTER AVE, STE 170, JANESVILLE, WI 535462

04/01/2018 03/31/2020PROFESSIONAL SERVICES GROUP, 2333 NORTHWESTERN AVE, RACINE, WI 534042

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2018 03/31/2020ADDISON ELEMENTARY, 5050 INDIAN ROAD, HARTFORD, WI 53027

02/04/2019 03/31/2020AMY BELLE ELEMENTARY, 3294 WILLOW CREEK RD, COLGATE, WI 53017

04/01/2018 03/31/2020BADGER MIDDLE SCHOOL, 727 S 6TH AVE, WEST BEND, WI 53095

02/04/2019 03/31/2020BRADFORD HIGH SCHOOL, 3700 WASHINGTON RD, KENOSHA, WI 53144

02/04/2019 03/31/2020BRASS ELEMENTARY SCHOOL, 6400 15TH AVE, KENOSHA, WI 53143

02/04/2019 03/31/2020BRISTOL ELEMENTARY SCHOOL, 20121 83RD ST, BRISTOL, WI 53104

07/24/2019 03/31/2020BROOKWOOD ELEMENTARY SCHOOL, 630 KOSSUTH STREET, GENOA CITY, WI 53128

07/24/2019 03/31/2020BROOKWOOD MIDDLE SCHOOL, 1020 HUNTERS RIDGE DR, GENOA CITY, WI 53128

02/04/2019 03/31/2020BULLEN MIDDLE SCHOOL, 2804 39TH AVE, KENOSHA, WI 53144

11/30/2018 03/31/2020BURLINGTON HIGH SCHOOL, 400 MCCANNA PKWY, BURLINGTON, WI 53105

07/24/2019 03/31/2020CARMEN HS OF SCIENCE - SO CAMPUS, 1712 S 32ND STREET, MILWAUKEE, WI 53215

10/22/2018 03/31/2020CENTRAL HIGH SCHOOL, 8516 W LINCOLN AVE, WEST ALLIS, WI 53227

04/01/2018 03/31/2020CENTRAL MIDDLE SCHOOL, 1100 CEDAR ST, HARTFORD, WI 53027

11/30/2018 03/31/2020COOPER ELEMENTARY SCHOOL, 249 CONKEY ST, BURLINGTON, WI 53105

04/01/2018 03/31/2020COUNTY LINE ELEMENTARY, W159 N9939 BUTTERNUT RD, GERMANTOWN, WI 53022

04/01/2018 03/31/2020DECORAH ELEMENTARY, 1225 SULVAN WAY, WEST BEND, WI 53095

02/04/2019 03/31/2020DOTTKE HIGH SCHOOL, 7815 W LAPHAM ST, MILWAUKEE, WI 53214

04/01/2018 03/31/2020DREAM CENTER, 1190 WESTERN DR, HARTFORD, WI 53027

11/30/2018 03/31/2020DYER INTERMEDIATE SCHOOL, 201 S KENDRICK AVE, BURLINGTON, WI 53105

02/04/2019 03/31/2020EARLY LEARNING CENTER, 244 LOOS ST, HARTFORD, WI 53027

10/22/2018 03/31/2020EDWARD BAIN SCHOOL OF LANG & ART, 2600 50TH ST, KENOSHA, WI 53140

04/01/2018 03/31/2020FAIRPARK ELEMENTARY SCHOOL, 519 INDIANA AVE, WEST BEND, WI 53095

02/04/2019 03/31/2020FARMINGTON ELEMENTARY, 8736 BOLTONVILLE RD, KEWASKUM, WI 53040

07/24/2019 03/31/2020FRANK ELEMENTARY SCHOOL, 1816 57TH STREET, KENOSHA, WI 53140

04/01/2018 03/31/2020GREAT EXPECTATIONS, 735 MAIN ST, WEST BEND, WI 53095

02/04/2019 03/31/2020GREEN TREE ELEMENTARY, 1330 GREEN TREE RD, WEST BEND, WI 53095

02/04/2019 03/31/2020GREWENOW ELEMENTARY SCHOOL, 7714 20TH AVE, KENOSHA, WI 53143

10/22/2018 03/31/2020HARTFORD UNION HIGH SCHOOL, 805 CEDAR ST, HARTFORD, WI 53027

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04/01/2018 03/31/2020HEADSTART, 737 S 3RD AVE, WEST BEND, WI 53095

02/04/2019 03/31/2020HIGHLAND ALTERNATIVE SCHOOL, 675 E ROSSMAN ST, HARTFORD, WI 53027

02/04/2019 03/31/2020HORACE MANN ELEMENTARY, 6213 W LAPHAM ST, WEST ALLIS, WI 53214

04/01/2018 03/31/2020I4 LEARNING, 5760 MOWHAWK RD, CAMPBELLSPORT, WI 53010

02/04/2019 03/31/2020IRVING ELEMENTARY, 10230 W GRANT ST, WEST ALLIS, WI 53227

02/04/2019 03/31/2020JACKSON ELEMENTARY, W204 N16850 JACKSON DR, JACKSON, WI 53037

02/04/2019 03/31/2020JEFFERSON ELEMENTARY, 7229 W BECHER ST, WEST ALLIS, WI 53219

11/30/2018 03/31/2020KARCHER MIDDLE SCHOOL, 225 ROBERT ST, BURLINGTON, WI 53105

04/01/2018 03/31/2020KENNEDY MIDDLE SCHOOL, W160 N11836 CRUSADER CT, GERMANTOWN, WI 53022

04/01/2018 03/31/2020KEWAKSUM MIDDLE SCHOOL, 1676 REIGLE DR, KEWASKUM, WI 53040

04/01/2018 03/31/2020KEWASKUM ELEMENTARY, 1415 BILGO LANE, KEWASKUM, WI 53040

04/01/2018 03/31/2020LAKEWOOD ELEMENTARY SCHOOL, 1218 WILMOT AVE, TWIN LAKES, WI 53181

02/04/2019 03/31/2020LANE ELEMENTARY, 2015 S SUNNYSLOPE RD, NEW BERLIN, WI 53151

04/01/2018 03/31/2020LINCOLN ELEMENTARY, 755 RURAL ST, HARTFORD, WI 53027

10/22/2018 03/31/2020LINCOLN MIDDLE SCHOOL, 6729 18TH AVE, KENOSHA, WI 53143

11/30/2018 03/31/2020LYONS CENTER SCHOOL, 1622 MILL ST, BURLINGTON, WI 53105

04/01/2018 03/31/2020MACARTHUR ELEMENTARY SCHOOL, N154 W11942 FOND DU LAC AVE, GERMANTOWN, WI 53022

02/04/2019 03/31/2020MADISON ELEMENTARY, 1117 104TH ST, WEST ALLIS, WI 53214

02/04/2019 03/31/2020MCKINLEY ELEMENTARY SCHOOL, 5520 32ND AVE, KENOSHA, WI 53144

04/01/2018 03/31/2020MCLANE ELEMENTARY, 833 CHESTNUT ST, WEST BEND, WI 53095

10/22/2018 03/31/2020NATHAN HALE HIGH SCHOOL, 11601 W LINCOLN AVE, WEST ALLIS, WI 53227

04/01/2018 03/31/2020PATHWAYS CHARTER, 1043 S MAIN ST, WEST BEND, WI 53095

10/22/2018 03/31/2020PERSHING ELEMENTARY SCHOOL, 1330 S 47TH ST, WEST MILWAUKEE, WI 53214

04/01/2018 03/31/2020RANDALL CONSOLIDATED SCHOOL, 37101 87TH ST, BURLINGTON, WI 53105

04/01/2018 03/31/2020RIVERVIEW ELEMENTARY SCHOOL, 300 E PROSSER ST, SILVER LAKE, WI 53170

04/01/2018 03/31/2020ROSSMAN ELEMENTARY, 600 HIGHLAND, HARTFORD, WI 53027

04/01/2018 03/31/2020SILVERBROOK INTERMEDIATE, 120 N SILVERBROOK RD, WEST BEND, WI 53095

04/01/2018 03/31/2020SLINGER MIDDLE SCHOOL, 521 OLYMPIC DR, SLINGER, WI 53086

02/04/2019 03/31/2020SOUTHPORT ELEMENTARY SCHOOL, 723 76TH ST, KENOSHA, WI 53143

02/04/2019 03/31/2020STOCKER ELEMENTARY SCHOOL, 6315 67TH ST, KENOSHA, WI 53142

07/24/2019 03/31/2020TREMPOR HIGH SCHOOL, 8560 26TH AVE, KENOSHA, WI 53143

10/22/2018 03/31/2020TREVOR-WILMOT GRADE SCHOOL, 26325 WILMOT RD, TREVOR, WI 53179

11/30/2018 03/31/2020UNION GROVE ELEMENTARY SCHOOL, 1745 MILLDRUM ST, UNION GROVE, WI 53182

02/04/2019 03/31/2020WALKER ELEMENTARY, 900 S 119TH ST, WEST ALLIS, WI 53214

11/30/2018 03/31/2020WALLER ELEMENTARY SCHOOL, 195 GARDNER AVE, BURLINGTON, WI 53105

10/22/2018 03/31/2020WASHINGTON MIDDLE SCHOOL, 811 WASHINGTON RD, KENOSHA, WI 53140

04/01/2018 03/31/2020WEST BEND EAST HIGH SCHOOL, 1305 E DECORAH RD, WEST BEND, WI 53095

10/22/2018 03/31/2020WHEATLAND CENTER SCHOOL, 6606 368TH AVE, BURLINGTON, WI 53105

04/01/2018 03/31/2020WILMOT UNION HIGH SCHOOL, 11112 308TH AVE, WILMOT, WI 53192

02/04/2019 03/31/2020WILSON ELEMENTARY SCHOOL, 4520 33RD AVE, KENOSHA, WI 53144

11/30/2018 03/31/2020WINKLER ELEMENTARY SCHOOL, 34150 FULTON ST, BURLINGTON, WI 53105

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1752PSYCHIATRIC AND PSYCHOTHERAPY CLINIC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202006/20/201906/01/1980

(262) 654-2434

(262) [email protected] DEFAZIO

County: KenoshaKENOSHA, WI 531426125 GREEN BAY RD, STE 700

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/20/2019 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/20/2019 04/30/2020

Services

NO BRANCH LOCATIONS

2433ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/28/2003

(262) 942-7740

(262) [email protected] SCHULTZ

County: KenoshaKENOSHA, WI 531429916 - 75TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 03/11/2019 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 03/11/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B)

03/11/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

KEWAUNEEKEWAUNEE

2288KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/1977

(920) 388-7124

(920) [email protected] BORKOVETZ

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

1466KEWAUNEE COUNTY DEPT OF HUMAN SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/1977

(920) 388-7124

(920) [email protected] NORTON

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2019 01/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

CSAS-PREVENTION DHS 75.04 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

2781KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/11/2008

(920) 388-7124

(920) [email protected] NORTON

County: KewauneeKEWAUNEE, WI 54216810 LINCOLN STREET

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

LA CROSSELA CROSSE

2802COUNSELING ASSOCIATES LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/05/2008

(608) 785-0273

(608) [email protected] EINSMAN

County: La CrosseLA CROSSE, WI 54601115 - 5TH AVENUE SOUTH, #301

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN 559872

3021DRIFTLESS RECOVERY SERVICES INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/14/2014

(608) 519-5908

(608) [email protected] KNUTSON

County: La CrosseLA CROSSE, WI 54601444 MAIN ST SUITE 301

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

3279FAMILY & CHILDREN'S CENTER COMMUNITY SUPPORT PROGRAM - LA CROSSE COUNTY

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/202001/01/2020

(608) 791-6262

(605) [email protected] BAILEY

County: La CrosseLA CROSSE, WI 546011707 MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1315FAMILY AND CHILDREN'S CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201902/01/1994

(608) 785-0002

(608) [email protected] JACOBSON

County: La CrosseLA CROSSE, WI 546011707 MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/11/2019 10/31/2021FAMILY AND CHILDREN'S CENTER, 1321 NORTH MAIN ST, VIROQUA, WI 546651

11/12/2019 10/31/2021FAMILY AND CHILDREN'S CENTER, 1321 N MAIN STREET, VIROQUA, WI 546652

Setting Begin/End DatesNon-Certified School Setting(s)11/01/2019 10/31/2021CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD., LA CROSSE, WI 54601

11/01/2019 10/31/2021HAMILTON EARLY LEARNING CTR, 1111 S. 7TH STREET, LA CROSSE, WI 54601

11/01/2019 10/31/2021LOGAN HIGH SCHOOL, 1500 RANGER DR, LACROSSE, WI 54603

11/01/2019 10/31/2021NORTHSIDE ELEMENTARY, 1611 KANE ST, LACROSSE, WI 54603

11/01/2019 10/31/2021SPENCE ELEMENTARY, 2150 BENNETT STREET, LA CROSSE, WI 54601

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Mental Health Program Directory By County, City, and Provider Name

1391GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/1984

(608) 775-2222

(608) [email protected] HAUG

County: La CrosseLA CROSSE, WI 546011836 SOUTH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/17/2019 01/31/2021GUNDERSEN BOSCOBEL AREA CLINIC, 200 W BLUFF STREET, BOSCOBEL, WI 538051

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD BEHAVIORAL HLTH, 110 JEFFERSON ST, WEST UNION, IA 521751

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 226 NORTH 2ND STREET, LA CRESCENT, MN 559471

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 35791 OSSEO ROAD, INDEPENDENCE, WI 547471

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 420 SOUTH PETERSON AVE, BLAIR, WI 546161

02/01/2019 01/31/2021GUNDERSEN HARMONY CLINIC, 805 COUNTY RD 44, HARMONY, MN 559391

02/01/2019 01/31/2021GUNDERSEN HOUSTON CLINIC, 511 E MAPLE ST, HOUSTON, MN 559431

02/01/2019 01/31/2021GUNDERSEN SPRING GROVE CLINIC, 123 5TH AVE SE, SPRING GROVE, MN 559741

07/17/2019 01/31/2021GUNDERSEN ST JOSEPHS, 400 WATER ST, HILLSBORO, WI 546341

02/01/2019 01/31/2021RICHLAND MEDICAL CENTER, 301 EAST 2ND STREET, RICHLAND CENTER, WI 535811

02/01/2019 01/31/2021VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 546651

02/01/2019 01/31/2021DAHL FAMILY YMCA, 1140 MAIN ST, LA CROSSE, WI 546012

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD BEHAVIORAL HLTH, 1111 W WISCONSIN ST, SPARTA, WI 546562

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 1830 STATE HWY 9, DECORAH, IA 521012

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 18606 ERVIN STREET, WHITEHALL, WI 547732

08/26/2019 01/31/2021GUNDERSEN CLINIC LTD, 505 GOPHER DRIVE, TOMAH, WI 546602

02/01/2019 01/31/2021GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 538212

02/01/2019 01/31/2021GUNDERSEN LUTHERAN MEDICAL CENTER, 123 - 16TH AVE SOUTH, ONALASKA, WI 546502

02/01/2019 01/31/2021GUNDERSEN LUTHERAN MEDICAL CENTER, 3111 GUNDERSEN DRIVE, ONALASKA, WI 546502

02/01/2019 01/31/2021GUNDERSEN VIROQUA CLINIC, 407 SOUTH MAIN STREET, VIROQUA, WI 546652

1520GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201903/01/1982

(608) 775-2222

(608) [email protected] HAUG

County: La CrosseLA CROSSE, WI 546011910 SOUTH AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 02/01/2019 01/31/2021

CSAS-NARCOTIC TREATMENT DHS 75.15 02/01/2019 08/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021GUNDERSEN LMC BEHAV HEALTH, 123 - 16TH AVENUE SO, ONALASKA, WI 546502

02/01/2019 01/31/2021GUNDERSEN LMC BEHAV HEALTH, 18606 ERVIN ST, WHITEHALL, WI 547732

02/01/2019 01/31/2021GUNDERSEN LMC CTR FOR VIOL PRE & INTER, 914 GREEN BAY ST, LA CROSSE, WI 546012

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Mental Health Program Directory By County, City, and Provider Name

1488LA CROSSE COUNTY HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/01/1978

(608) 785-6122

(608) [email protected] OINES

County: La CrosseLA CROSSE, WI 54601300 N 4TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020LAKEVIEW HEALTH CENTER, 902 GARLAND ST, WEST SALEM, WI 546691

05/01/2018 04/30/2020RAVENWOOD, 902 GARLAND ST. EAST, WEST SALEM, WI 546691

05/01/2018 04/30/2020ROLLING HILLS, 14346 COUNTY HWY B, SPARTA, WI 546561

1362MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201909/01/1977

(608) 392-9793

(608) [email protected] SOWDERS

County: La CrosseLA CROSSE, WI 54601212 S 11TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 06/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - BELLE SQUARE, 232 3RD ST N STE #100, LA CROSSE, WI 546011

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 1303 MAIN STREET, HOLMEN, WI 546362

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - MENS RECOVERY HOUSE, 1005 JACKSON STREET, LA CROSSE, WI 54601

2

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 546502

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU CHIEN, WI 53821

2

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - SPARTA, 310 WEST MAIN STREET, SPARTA, WI 546562

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - TOMAH, 325 BUTTS AVENUE, TOMAH, WI 546602

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN - WOMENS RECOVERY HOUSE, 518 SO 10TH STREET, LA CROSSE, WI 54601

2

06/01/2019 05/31/2021MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 546012

06/01/2019 05/31/2021MAYO CLINIC FRANSISCAN - ARCADIA, 895 SO DETTLOFF DRIVE, ARCADIA, WI 546122

06/01/2019 05/31/2021MAYO CLINIC FRANSISCAN - GERARD HALL, 940 DIVISION STREET, LA CROSSE, WI 546012

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Mental Health Program Directory By County, City, and Provider Name

3005PEACE OF MIND COUNSELING

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/2013

(608) 782-4426

(608) [email protected] CLARK

County: La CrosseLA CROSSE, WI 54601115 - 5TH AVENUE SOUTH, SUITE 507

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/29/2019 07/31/2020PEACE OF MIND - BLACK RIVER FALLS, 920 FILLMORE ST, BLACK RIVER FALLS, WI 546152

11/28/2018 07/31/2020PEACE OF MIND - LA CRESCENT, 136 S WALNUT ST, LA CRESCENT, MN 559472

08/01/2018 07/31/2020PEACE OF MIND - SPARTA, 103 S WATER ST, SPARTA, WI 546562

11/01/2019 07/31/2020PEACE OF MIND - SPARTA, 107 E OAK ST, SPARTA, WI 546562

08/01/2018 07/31/2020PEACE OF MIND CNSLNG - WINONA MN, 902 E 2ND ST, SUITE 322, WINONA, MN 559872

08/01/2018 07/31/2020ARCADIA ELEMENTARY SCHOOL, 358 EAST RIVER ST, ARCADIA, WI 546123

08/01/2018 07/31/2020ARCADIA MIDDLE/HIGH SCHOOL, 756 RAIDER DR, ARCADIA, WI 546123

08/01/2018 07/31/2020BLACK RIVER FALLS HIGH SCHOOL, 1200 PIERCE STREET, BLACK RIVER FALLS, WI 546153

08/01/2018 07/31/2020BLACK RIVER FALLS MIDDLE SCHOOL, 1202 PIERCE ST, BLACK RIVER FALLS, WI 546153

08/01/2018 07/31/2020BLAIR-TAYLOR SCHOOL DISTRICT, N31024 ELLAND ROAD, BLAIR, WI 546163

08/01/2018 07/31/2020CASHTON ELEMENTARY, 436 FRONT ST, CASHTON, WI 546193

08/01/2018 07/31/2020CATARACT ELEMENTARY SCHOOL, 6070 STATE HWY 27, SPARTA, WI 546563

08/01/2018 07/31/2020CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI 546013

08/01/2018 07/31/2020COCHRANE-FOUNTAIN CITY SCHOOL DISTRICT, S2770 STATE HIWY 35, FOUNTAIN CITY, WI 546293

08/01/2018 07/31/2020COULEE CONNECTIONS, 99 MILWAUKEE ST, LA CROSSE, WI 546013

08/01/2018 07/31/2020COULEE REGION ALTERNATIVE SCHOOL, 20873 COLLEGE AVENUE, GALESVILLE, WI 546303

08/01/2018 07/31/2020DE SOTO MIDDLE/HIGH SCHOOL, 615 MAIN ST, DE SOTO, WI 546243

08/01/2018 07/31/2020EMERSON ELEMENTARY SCHOOL, 2102 CAMPBELL ROAD, LA CROSSE, WI 546013

08/01/2018 07/31/2020EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 546363

08/01/2018 07/31/2020FORREST STREET EARLY LEARNING CENTER, 720 FORREST ST, BLACK RIVER FALLS, WI 546153

08/01/2018 07/31/2020G-E-T ELEMENTARY SCHOOL - GALESVILLE, 17151 FRENCH RD, GALESVILLE, WI 546303

08/01/2018 07/31/2020G-E-T HIGH SCHOOL, 17511 NORTH MAIN ST, GALESVILLE, WI 546303

08/01/2018 07/31/2020G-E-T MIDDLE SCHOOL, 19650 PRAIRIE RIDGE LANE, GALESVILLE, WI 546303

08/01/2018 07/31/2020HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI 546013

08/01/2018 07/31/2020HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN ST, SPARTA, WI 546563

08/01/2018 07/31/2020HOLMEN HIGH SCHOOL, 1001 MCHUGH ROAD, HOLMEN, WI 546363

08/01/2018 07/31/2020HOLMEN MIDDLE SCHOOL, 502 N MAIN STREET, HOLMEN, WI 546363

08/01/2018 07/31/2020INDEPENDENCE K-12, 23786 INDEE BLVD, INDEPENDENCE, WI 547473

08/01/2018 07/31/2020LA CRESCENT ELEMENTARY, 504 SOUTH OAK STREET, LA CRESCENT, MN 559473

08/01/2018 07/31/2020LA CRESCENT MS/HS, 1301 LANCER BLVD, LA CRESCENT, MN 559473

08/01/2018 07/31/2020LAKEVIEW MONTESSORI SCHOOL, 711 PINE ST, SPARTA, WI 546563

08/01/2018 07/31/2020LAWRENCE-LAWSON ELEMENTARY SCHOOL, 429 N BLACK RIVER ST, SPARTA, WI 546563

09/13/2019 07/31/2020LINCOLN ELEMENTARY SCHOOL, 207 EAST PEARL, MERRILLAN, WI 547543

09/13/2019 07/31/2020LINCOLN MS/HS, 124 S SCHOOL STREET, ALMA CENTER, WI 546113

08/01/2018 07/31/2020LOGAN HIGH SCHOOL, 1500 RANGER DR, LA CROSSE, WI 546013

08/01/2018 07/31/2020MAPLEWOOD ELEMENTARY SCHOOL, 900 E MONTGOMERY ST, SPARTA, WI 546563

08/01/2018 07/31/2020MEADOWVIEW INTERMEDIATE SCHOOL, 125 N WATER ST, SPARTA, WI 546563

08/01/2018 07/31/2020NORTHSIDE ELEMENTARY, 1611 KANE ST, LA CROSSE, WI 546013

08/01/2018 07/31/2020ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 546503

08/01/2018 07/31/2020ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI 546503

08/01/2018 07/31/2020PRAIRIE VIEW ELEMENTARY, 1201 NEWPORT LANE, HOLMEN, WI 546363

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08/01/2018 07/31/2020RED CREEK ELEMENTARY, 410 HIGHWAY A, BLACK RIVER FALLS, WI 546153

08/01/2018 07/31/2020SAND LAKE ELEMENTARY, 3600 SAND LAKE ROAD, HOLMEN, WI 546363

08/01/2018 07/31/2020SOUTHSIDE ELEMENTARY, 1023 WALRATH ST, SPARTA, WI 546563

08/01/2018 07/31/2020SPARTA ALT IND LEARNING SCHOOLS (SAILS), 201 E FRANKLIN ST, SPARTA, WI 546563

08/01/2018 07/31/2020SPARTA HIGH SCHOOL, 506 N BLACK RIVER ST, SPARTA, WI 546563

08/01/2018 07/31/2020SPARTA MEADOWVIEW MIDDLE SCHOOL, 1225 N BLACK RIVER ST, SPARTA, WI 546563

08/01/2018 07/31/2020STODDARD ELEMENTARY SCHOOL, 300 N. COTTAGE ST., STODDARD, WI 546583

08/01/2018 07/31/2020VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI 546363

08/01/2018 07/31/2020WHITEHALL SCHOOL DISTRICT, 19121 HOBSON ST, WHITEHALL, WI 547733

3044WESTERN REGION INTEGRATED CARE CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/04/2014

(608) 785-6122

(608) [email protected] ENGLING

County: La CrosseLA CROSSE, WI 54602300 - 4TH STREET NORTH

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/30/2019 06/30/2020JACKSON COUNTY HUMAN SERVICES - CCS, 421 COUNTY RD R, BLACK RIVER FALLS, WI 546152

12/03/2018 06/30/2020MONROE COUNTY HUMAN SERVICES CCS, 112 S COURT ST RM 3000, SPARTA, WI 546562

3058WESTERN REGION INTEGRATED CARE CONSORTIUM (WRIC) CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201811/01/2014

(608) 791-6262

(608) [email protected] YUTUC

County: La CrosseLA CROSSE, WI 546011707 MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2018 12/31/2019FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 221 MAIN ST., STE. L101, BLACK RIVER

FALLS, WI 546152

01/01/2018 12/31/2019FAMILY & CHILDREN'S CENTER, MONROE COUNTY OFFICE, 920 WEST WISCONSIN, SPARTA, WI 54656

2

ONALASKA

2280GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2000

(608) 775-6055

(608) [email protected] HAUG

County: La CrosseONALASKA, WI 54650123 - 16TH AVENUE, SOUTH

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2018 11/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2778LIVING WELL CHRISTIAN FAMILY CLINIC, LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2008

(608) 783-1456

(608) [email protected] LIPPS

County: La CrosseONALASKA, WI 54650575 LESTER AVENUE STE #100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

2467STEIN COUNSELING AND CONSULTING SERVICES, LTD

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201908/06/2003

(608) 785-7477

(608) [email protected] STEIN

County: La CrosseONALASKA, WI 54650571 BRAUND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021STEIN COUNSELING AND CONSULTING SERVICES, 206 ROOSEVELT RD STE 147, BLACK RIVER

FALLS, WI 546152

09/01/2019 08/31/2021MELROSE-MINDORO JR/SR HIGH, N181 STATE ROAD 108, MELROSE, WI 546423

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2019 08/31/2021CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD S, LA CROSSE, WI 54601

09/01/2019 08/31/2021EAGLE BLUFF ELEMENTARY, 200 EAGLE BLUFF COURT, ONALASKA, WI 54650

09/01/2019 08/31/2021EMERSON ELEMENTARY, 2101 CAMPBELL RD, LA CROSSE, WI 54601

09/01/2019 08/31/2021HAMILTON ELEMENTARY, 111 7TH STREET S, LA CROSSE, WI 54601

09/01/2019 08/31/2021LINCOLN MIDDLE SCHOOL, 510 9TH STREET S, LA CROSSE, WI 54601

09/01/2019 08/31/2021LOGAN HIGH SCHOOL, 1500 RANGOR DR, LA CROSSE, WI 54603

09/01/2019 08/31/2021LOGAN MIDDLE SCHOOL, 1450 AVON ST, LA CROSSE, WI 54601

09/01/2019 08/31/2021LONGFELLOW MIDDLE SCHOOL, 1900 DENTON ST, LA CROSSE, WI 54601

09/01/2019 08/31/2021NORTHERN HILLS ELEMENTARY, 910 EAST AVE NORTH, ONALASKA, WI 54650

09/01/2019 08/31/2021NORTHSIDE ELEMENTARY, 1611 KANE ST, LA CROSSE, WI 54603

09/01/2019 08/31/2021ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650

09/01/2019 08/31/2021ONALASKA MIDDLE SCHOOL, 711 QUINCY ST, ONALASKA, WI 54650

09/01/2019 08/31/2021PERTZCH ELEMENTARY, 524 MAIN ST, ONALASKA, WI 54650

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Mental Health Program Directory By County, City, and Provider Name

LAFAYETTEDARLINGTON

1490LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/01/1975

(608) 776-4914

(608) [email protected] SCHUHMACHER

County: LafayetteDARLINGTON, WI 5353015701 COUNTY ROAD K STE 3

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2279LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2000

(608) 776-4914

(608) [email protected] SCHUHMACHER

County: LafayetteDARLINGTON, WI 5353015701 COUNTY ROAD K

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

LANGLADEANTIGO

2890LANGLADE HOSPITAL GENERAL CLINIC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/30/202108/01/201907/27/2010

(715) 627-6183

(715) [email protected] WILLIAMS

County: LangladeANTIGO, WI 54409110 E FIFTH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/30/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/30/2021ASPIRUS MERRILL CLINIC, 3333 EAST MAIN ST, MERRILL, WI 544521

08/01/2019 07/30/2021ASPIRUS ELCHO CLINIC, W10618 CLINIC DR, ELCHO, WI 544282

ELCHO

2533WETZEL-RASMUSSEN COUNSELING SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2004

(715) 275-4510

(715) [email protected] WETZEL-RASMUSSEN

County: LangladeELCHO, WI 54428N11230 ANTIGO STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2019 06/30/2021ELCHO SCHOOL DISTRICT, N11268 ANTIGO STREET, ELCHO, WI 54428

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Mental Health Program Directory By County, City, and Provider Name

LINCOLNTOMAHAWK

2806PSYCHOLOGICAL RESOURCE CENTER, LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/01/2008

(715) 224-2106

(715) [email protected] K MCCLUSKEY

County: LincolnTOMAHAWK, WI 544871218 N 4TH STREET, #108

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020TOMAHAWK SCHOOLS, 1048 EAST KING RD, TOMAHAWK, WI 544873

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Mental Health Program Directory By County, City, and Provider Name

MANITOWOCMANITOWOC

1555MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/01/1975

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54220926 S. 8TH STREET

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2285MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/01/1975

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54220926 S. 8TH STREET

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2711MANITOWOC COUNTY HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201902/06/2007

(920) 683-4243

(920) [email protected] FURE

County: ManitowocMANITOWOC, WI 54220926 S. 8TH STREET

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 03/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

TWO RIVERS

1386AURORA BEHAVIORAL HEALTH CENTER - MANITOWOC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201809/01/1993

(920) 793-7430

(920) [email protected] ROLLIN

County: ManitowocTWO RIVERS, WI 542415300 MEMORIAL DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1591PHOENIX BEHAVIORAL HEALTH SERVICES, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201808/26/1991

(920) 657-1784

(920) [email protected] WILCOX

County: ManitowocTWO RIVERS, WI 542413120 MEMORIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/09/2019 10/31/2020PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 1600 SHAWANO AVE #100, GREEN BAY, WI 543031

11/01/2018 10/31/2020PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 2619 C POST ROAD STE 2, STEVENS POINT, WI 54481

1

Setting Begin/End DatesNon-Certified School Setting(s)11/01/2018 10/31/2020PBHS KEWAUNEE HIGH SCHOOL, 911 3RD STREET, KEWAUNEE, WI 54216

11/01/2018 10/31/2020PBHS LIGHTHOUSE LEARNING ACADEMY, 4521 LINCOLN AVE, TWO RIVERS, WI 54241

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Mental Health Program Directory By County, City, and Provider Name

MARATHONMARSHFIELD

2981CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/27/2012

(715) 384-2724

(715) [email protected] ANTONIEWICZ

County: MarathonMARSHFIELD, WI 544492001 S CENTRAL AVE, STE A-B

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC, 3930 8TH STREET SO, STE 101, WISCONSIN

RAPIDS, WI 544942

09/01/2018 08/31/2020ABBOTSFORD ELEMENTARY SCHOOL, 510 W HEMLOCK STREET, ABBOTSFORD, WI 544053

09/01/2018 08/31/2020ALEXANDER MIDDLE SCHOOL, 540 BIRCH STREET, NEKOOSA, WI 544573

09/01/2018 08/31/2020ALMOND - BANCROFT SCHOOL, 1336 ELM ST, ALMOND, WI 549093

09/01/2018 08/31/2020COLBY ELEMENTARY SCHOOL, 202 WEST DOLF STREET PO BOX 80, COLBY, WI 544213

09/01/2018 08/31/2020COLBY HIGH SCHOOL, 703 N 2ND STREET, COLBY, WI 544213

09/01/2018 08/31/2020HUMKE ELEMENTARY, 500 S. SECTION STREET, NEKOOSA, WI 544573

09/01/2018 08/31/2020NEKOOSA HIGH SCHOOL, 500 CEDAR ST, NEKOOSA, WI 544573

09/01/2018 08/31/2020PITTSVILLE ELEMENTARY SCHOOL, 5459 ELEMENTARY AVE #1, PITTSVILLE, WI 544663

09/01/2018 08/31/2020PITTSVILLE HIGH SCHOOL, 5407 1ST AVENUE, PITTSVILLE, WI 544663

09/01/2018 08/31/2020SPENCER HIGH SCHOOL, 300 SCHOOL STREET, SPENCER, WI 544793

09/01/2018 08/31/2020STRATFORD ELEMENTARY SCHOOL, 522 N. 3RD AVENUE, STRATFORD, WI 544843

09/01/2018 08/31/2020WISCONSIN RAPIDS AREA MIDDLE SCHOOL, 1921 27TH AVENUE SOUTH, WISCONSIN RAPIDS, WI 54495

3

3217GATEWAYS COUNSELING SERVICES LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201907/05/2018

(715) 898-1240

(715) [email protected] MESSICK

County: MarathonMARSHFIELD, WI 544491905 S CENTRAL AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2019 07/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021GATEWAYS COUNSELING SERVICES, 510 W 5TH STREET, NEILLSVILLE, WI 544562

10/25/2019 07/31/2021GATEWAYS COUNSELING SERVICES, 7350 US HWY 12, BLACK RIVER FALLS, WI 546152

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Mental Health Program Directory By County, City, and Provider Name

WAUSAU

2719ACHIEVE CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2007

(715) 845-4970

(715) [email protected] WESLEY

County: MarathonWAUSAU, WI 54401520 NORTH 28TH AVE, #200

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2018 03/31/2020DC EVEREST HIGH SCHOOL, 6500 ALDERSON ST, SCHOFIELD, WI 54476

04/01/2018 03/31/2020DC EVEREST IDEA/ODYSSEY, 4704 CAMP PHILLIPS RD, WESTON, WI 54476

04/01/2018 03/31/2020DC EVEREST JUNIOR HIGH, 1000 MACHMILLER ST, SCHOFIELD, WI 54476

04/01/2018 03/31/2020HORACE MANN MIDDLE SCHOOL, 3101 NORTH 13TH ST, WAUSAU, WI 54403

04/01/2018 03/31/2020PEER PROGRAM, 111 E. THOMAS ST, WAUSAU, WI 54401

04/01/2018 03/31/2020ROSHOLT SCHOOL, 346 W RANDOLPH ST, ROSHOLT, WI 54473

2873ACS CLINICAL SERVICES, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/15/2009

(715) 355-0667

(715) [email protected] YEAGER

County: MarathonWAUSAU, WI 54403903 N 2ND STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

1153CENTER FOR HUMAN DEVELOPMENT

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/01/1996

(715) 845-6477

(715) [email protected] WEBSTER

County: MarathonWAUSAU, WI 54403631 FOREST STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021CENTER FOR HUMAN DEVELOPMENT INC, 1509 N FOURTH ST, SUITE 2, TOMAHAWK, WI 544871

12/04/2019 11/30/2021ATHENS GRADE SCHOOL, 209 SCHLEGEL ST, ATHENS, WI 544113

12/01/2019 11/30/2021ATHENS MIDDLE/HIGH SCHOOL, 601 W LIMIT RD, ATHENS, WI 544113

12/01/2019 11/30/2021JEFFERSON ELEMENTARY SCHOOL, 1914 W JACKSON ST, MERRILL, WI 544523

12/01/2019 11/30/2021KATE GOODRICH ELEMENTARY SCHOOL, 505 W 10TH ST, MERRILL, WI 544523

12/01/2019 11/30/2021MERRILL HIGH SCHOOL, 1201 NORTH SALES STREET, MERRILL, WI 544523

12/01/2019 11/30/2021PRAIRIE RIVER MIDDLE SCHOOL, 106 POLK STREET, MERRILL, WI 544523

12/01/2019 11/30/2021TOMAHAWK K-12, 1048 E KING RD, TOMAHAWK, WI 544873

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2464CHARIS COUNSELING, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/2003

(715) 848-8665

(715) [email protected] THOMPSON

County: MarathonWAUSAU, WI 544012620 W. STEWART AVENUE, #310

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020CHARIS COUNSELING, LLC, 101 W MC MILLAN STREET, #2B, MARSHFIELD, WI 544492

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2018 08/31/2020THOMAS JEFFERSON ELEMENTARY SCHOOL, 500 RANDOLPH ST, WAUSAU, WI 54401

1185CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201812/01/1983

(715) 848-2959

(715) [email protected] HANSON

County: MarathonWAUSAU, WI 54401705 S. 24TH AVENUE, #402

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/30/2018 12/31/2019CHILDREN'S SERVICE SOCIETY OF WI - MARSHFIELD, 725 S CENTRAL AVE, MARSHFIELD, WI 544492

01/01/2018 12/31/2019CHILDREN'S SERVICE SOCIETY OF WI-STEVENS PT, 1466 WATER STREET, STEVENS POINT, WI 54481

2

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2018 12/31/2019CHARLES F FERNANDEZ CENTER, 1025 CLARK STREET, STEVENS POINT, WI 54481

01/01/2018 12/31/2019JEFFERSON ELEMENTARY, 1800 EAST AVE, STEVENS POINT, WI 54481

01/01/2018 12/31/2019MADISON ELEMENTARY, 600 MARIA DRIVE, STEVENS POINT, WI 54481

01/01/2018 12/31/2019MARSHFIELD HIGH SCHOOL, 1401 E BECKER ROAD, MARSHFIELD, WI 54449

01/01/2018 12/31/2019MCDILL ELEMENTARY, 2516 SCHOOL STREET, STEVENS POINT, WI 54481

01/01/2018 12/31/2019MCKINLEY ELEMENTARY, 2926 BLAINE STREET, STEVENS POINT, WI 54481

01/01/2018 12/31/2019NEILLSVILLE ELEMENTARY SCHOOL, 504 E FIFTH STREET, NEILLSVILLE, WI 54456

01/01/2018 12/31/2019NEILLSVILLE HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456

10/26/2018 12/31/2019TOMAHAWK ELEMENTARY SCHOOL, 1048 E KING RD, TOMAHAWK, WI 54487

10/26/2018 12/31/2019WAUSAU SCHOOL DISTRICT, 415 SEYMOUR ST, WAUSAU, WI 54402

2349DIX & GILLETTE COUNSELING SERVICES, LLP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/01/2001

(715) 675-2988

(715) [email protected] DIX

County: MarathonWAUSAU, WI 544011720 MERRILL AVE SUITE 401

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

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1299ELMERGREEN ASSOCIATES, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/05/1992

(715) 845-7142

(715) [email protected] ELMERGREEN

County: MarathonWAUSAU, WI 54403114 GRAND AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

1677NORTH CENTRAL HEALTH CARE

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201910/01/1975

(715) 848-2362

(715) [email protected] LOY

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

CSAS-AMBULATORY DETOXIFICATION DHS 75.08 03/01/2019 02/28/2021

CSAS-DAY TREATMENT DHS 75.12 03/01/2019 02/28/2021

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2019 02/28/2021

CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 03/01/2019 02/28/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2019 11/29/2019

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 03/01/2019 02/28/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 03/01/2019 02/28/2021

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2019 02/28/2021

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021ANTIGO CENTER, 1225 LANGLADE ROAD, ANTIGO, WI 544092

03/01/2019 02/28/2021MERRILL CENTER, 607 N SALES STREET, #309, MERRILL, WI 544522

03/01/2019 02/28/2021TOMAHAWK OFFICE, 213 WEST WISCONSIN AVE, TOMAHAWK, WI 544872

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2019 02/28/2021DC EVEREST SENIOR HIGH, 6500 ALDERSON STREET, SCHOFIELD, WI 54476

03/01/2019 02/28/2021MOSINEE ELEMENTARY SCHOOL, 600 12TH STREET, MOSINEE, WI 54455

03/01/2019 02/28/2021MOSINEE HIGH SCHOOL, 1000 HIGH STREET, MOSINEE, WI 54455

03/01/2019 02/28/2021MOSINEE MIDDLE SCHOOL, 700 HIGH STREET, MOSINEE, WI 54455

3041NORTH CENTRAL HEALTH CARE CCS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202007/01/2014

(715) 841-5146

(715) [email protected] HINTZ

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL UNIFIED BOARD DHS 36 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 1225 LANGLADE ROAD, ANTIGO, WI 544092

01/01/2020 12/31/2021NORTH CENTRAL HEALTH CARE - LINCOLN COUNTY, 607 N SALES ST STE 309, MERRILL, WI 544522

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2297NORTH CENTRAL HEALTH CARE CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202010/01/1975

(715) 841-5146

(715) [email protected] HINTZ

County: MarathonWAUSAU, WI 544031100 LAKE VIEW DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021NORTH CENTRAL HEALTH CARE CSP - LANGLADE, 1225 LANGLADE ROAD, ANTIGO, WI 544092

01/01/2020 12/31/2021NORTH CENTRAL HEALTH CARE CSP - LINCOLN, 607 N SALES ST STE 309, MERRILL, WI 544522

2404NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - WAUSAU

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201909/18/2002

(888) 226-8713

(715) [email protected] MAURER

County: MarathonWAUSAU, WI 544015655 N 28TH AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2019 01/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

02/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2715PEACEFUL SOLUTIONS COUNSELING

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2007

(715) 675-7238

(715) [email protected] SHIPWAY

County: MarathonWAUSAU, WI 54403741 NORTH 1ST STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020PEACEFUL SOLUTIONS COUNSELING, 726 EAST 2ND STREET, MERRILL, WI 544521

09/11/2019 02/29/2020EDGAR PUBLIC SCHOOL, 203 E BIRCH ST, EDGAR, WI 544263

03/01/2018 02/29/2020WAUSAU EAST HIGH SCHOOL, 2607 NORTH 18TH STREET, WAUSAU, WI 544033

2879PRIMARY CONNECTION HEALTH CARE, INC. DBA BRIDGE COMMUNITY HEALTH CLINIC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/2009

(715) 845-5385

(715) [email protected] KELESKE

County: MarathonWAUSAU, WI 544031810 N SECOND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3179THE CARING TREE - CHILDREN'S COUNSELING CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/22/201908/04/2017

(715) 870-2267

(715) [email protected] LOOMANS

County: MarathonWAUSAU, WI 544012804 RIB MOUNTAIN DRIVE, STE D

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/22/2019 07/31/2020

Services

NO BRANCH LOCATIONS

1909THE CENTRE FOR WELL-BEING INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201902/17/1992

(888) 778-6750

(715) [email protected] SALZMAN

County: MarathonWAUSAU, WI 54403901 N 6TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021THE CENTRE FOR WELL-BEING, 310A N BROWN ST, RHINELANDER, WI 545012

09/01/2019 08/31/2021THE CENTRE FOR WELL-BEING, 4601 CAMP PHILLIPS RD, WESTON, WI 544762

09/01/2019 08/31/2021THE CENTRE FOR WELL-BEING, 607 CEDAR AVE, MERRILL, WI 544522

09/01/2019 08/31/2021WAUSAU WEST HIGH SCHOOL, 1200 WEST WAUSAU AVENUE, WAUSAU, WI 544013

WESTON

2752ASPIRUS BEHAVIORAL MEDICINE CLINIC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2007

(715) 241-5448

(715) [email protected] WILLIAMS

County: MarathonWESTON, WI 544764005 COMMUNITY CENTER DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021ASPIRUS ANTIGO CLINIC, 112 EAST 5TH AVE, ANTIGO, WI 544091

03/01/2019 02/28/2021ASPIRUS HOUGHTON CLINIC, 1000 CEDAR ST, HOUGHTON, MI 499311

03/01/2019 02/28/2021ASPIRUS MEDFORD CLINIC, 143 S GIBSON ST, MEDFORD, WI 544511

03/01/2019 02/28/2021ASPIRUS WESTON CLINIC - WI RAPIDS OUTREACH, 410 DEWEY ST, WISCONSIN RAPIDS, WI 544941

03/01/2019 02/28/2021ASPIRUS RHINELANDER OUTREACH, 1630 N CHIPPEWA DR, RHINELANDER, WI 545012

11/11/2019 02/28/2021ASPIRUS WAUSAU FAMILY CLINIC, 4005 WINDRIDGE DR, WAUSAU, WI 544012

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2939COMPASS COUNSELING WAUSAU, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/25/2011

(715) 298-6365

(715) [email protected] PETERSON

County: MarathonWESTON, WI 544763704 WESTON AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/08/2019 03/31/2020COMPASS COUNSELING WAUSAU, LLC, 2811 8TH ST S, STE 60, WISCONSIN RAPIDS, WI 544942

04/01/2018 03/31/2020COMPASS COUNSELING WAUSAU, LLC, 530 GRANT ST, WAUSAU, WI 544032

07/22/2019 03/31/2020COMPASS COUNSELING, 718 GRAND AVE, SCHOFIELD, WI 544762

10/24/2018 03/31/2020AMHERST SCHOOLS, 357 N MAIN ST, AMHERST, WI 544063

10/24/2018 03/31/2020PORT EDWARDS ELEMENTARY, 951 5TH ST, PORT EDWARDS, WI 544693

10/24/2018 03/31/2020PORT EDWARDS HIGH/MIDDLE, 801 2ND ST, PORT EDWARDS, WI 544693

11/18/2019 03/31/2020ROTHSCHILD ELEMENTARY SCHOOL, 801 1ST ST, ROTHSCHILD, WI 544743

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Mental Health Program Directory By County, City, and Provider Name

MARINETTEMARINETTE

3074MARINETTE AND OCONTO COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/01/2015

(715) 732-7711

(715) [email protected] GERBYSHAK

County: MarinetteMARINETTE, WI 541432500 HALL AVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 10/01/2018 09/30/2020

CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 36 10/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2018 09/30/2020OCONTO COUNTY DEPT. OF HEALTH AND HUMAN SERVICES, 501 PARK AVE., OCONTO, WI 541531

1559MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT / ADAPT

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201901/01/1982

(715) 732-7711

(715) [email protected] FREEMAN

County: MarinetteMARINETTE, WI 541432500 HALL AVENUE

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021MARINETTE COUNTY HHSD/ADAPT, 1201 JACKSON STREET, NIAGARA, WI 541512

2340MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201901/01/1982

(715) 732-7766

(715) [email protected] BREAULT

County: MarinetteMARINETTE, WI 541432500 HALL AVENUE, #A

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

MARQUETTEMONTELLO

1560MARQUETTE COUNTY HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201803/01/1981

(608) 297-2148

(608) [email protected] WEBB

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

CSAS-PREVENTION DHS 75.04 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020MONTELLO SCHOOLS, 222 FOREST LANE, MONTELLO, WI 539493

05/01/2018 04/30/2020WESTFIELD ELEMENTARY SCHOOL, 329 HAWK LANE, WESTFIELD, WI 539643

05/01/2018 04/30/2020WESTFIELD MIDDLE/HIGH SCHOOL, N7046 COUNTY ROAD M, WESTFIELD, WI 539643

3108MARQUETTE COUNTY HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/01/2016

(608) 297-2148

(608) [email protected] WEBB

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2019 12/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 01/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

3125MARQUETTE COUNTY HUMAN SERVICES - CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/28/2016

(608) 297-2148

(608) [email protected] WEBB

County: MarquetteMONTELLO, WI 53949480 UNDERWOOD AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2019 02/28/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 03/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WESTFIELD

1693NORTHLAND COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201801/01/1983

(608) 296-1590

(608) [email protected] JON MATTHEW

County: MarquetteWESTFIELD, WI 53964161 SPRING STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020NORTHLAND COMMUNITY SERVICES, 139 S MAIN, PO BOX 1178, ADAMS, WI 539101

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Mental Health Program Directory By County, City, and Provider Name

MENOMINEEKESHENA

1587MENOMINEE COUNTY HUMAN SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201911/01/1994

(715) 799-3517

(715) [email protected] REID

County: MenomineeKESHENA, WI 54135W3272 WOLF RIVER ROAD

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 05/01/2019 04/30/2021

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 05/01/2019 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2019 04/30/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 05/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2228MENOMINEE COUNTY HUMAN SERVICES CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201911/01/1994

(715) 799-3517

(715) [email protected] DOWN

County: MenomineeKESHENA, WI 54135W3272 WOLF RIVER ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

1588MENOMINEE TRIBAL CLINIC, BEHAVIORAL HEALTH SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/03/1993

(715) 799-3929

(715) [email protected] OPPER

County: MenomineeKESHENA, WI 54135W3275 WOLF RIVER DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

MILWAUKEEBROWN DEER

3255AMERICAN RELAXATION COUNSELING SERVICE, LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201906/01/2019

() -

(262) [email protected] FORD

County: MilwaukeeBROWN DEER, WI 532235600 W BROWN DEER RD STE 106

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2020

Services

NO BRANCH LOCATIONS

2882REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/01/2009

(414) 371-1400

(414) [email protected] PUMPHREY

County: MilwaukeeBROWN DEER, WI 532234550 W BRADLEY ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

2532ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/13/2004

(414) 355-9665

(414) [email protected] SCHULTZ

County: MilwaukeeBROWN DEER, WI 532234555 W SCHROEDER DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2019 06/30/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 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-DAY TREATMENT DHS 61.75 07/01/2019 06/30/2021

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 07/01/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

3084ROGERS MEMORIAL HOSPITAL, INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/28/2015

(414) 797-0804

(414) [email protected] SCHULTZ

County: MilwaukeeBROWN DEER, WI 532234600 WEST SCHROEDER DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/2018 03/31/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 04/01/2018 03/31/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 04/01/2018 03/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

CUDAHY

1867AURORA HEALTH CARE METRO, INC. DBA AURORA ST. LUKE'S SOUTH SHORE

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201811/01/1989

(414) 489-4056

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeCUDAHY, WI 531105900 S. LAKE DRIVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/2018 09/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

FRANKLIN

1650AURORA BEHAVIORAL HEALTH - FRANKLIN

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/02/1994

(414) 529-9188

(414) [email protected] VALENTIN

County: MilwaukeeFRANKLIN, WI 531329200 W. LOOMIS ROAD, #217

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/29/2019 04/30/2021AURORA BEHAVIORAL HEALTH CENTER - 84 SOUTH, 9000 SURA LANE, GREENFIELD, WI 532282

05/01/2019 04/30/2021AURORA BEHAVIORAL HEALTH CENTER - LAYTON, 2000 E. LAYTON AVE., STE 250, SAINT FRANCIS, WI 53235

2

05/01/2019 04/30/2021AURORA BEHAVIORAL HEALTH CENTER-LAKESHORE, 3611 CHICAGO AVE, SOUTH MILWAUKEE, WI 53172

2

05/01/2019 04/30/2021AURORA BEHAVIORAL SERVICES-MUSKEGO WEST, S74W16775 JANESVILLE RD, MUSKEGO, WI 53150

2

GLENDALE

1335AURORA BEHAVIORAL HEALTH NORTH SHORE

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/1985

(414) 454-6450

(414) [email protected] BAHR

County: MilwaukeeGLENDALE, WI 532176980 N PORT WASHINGTON #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020AURORA BEHAVIORAL HEALTH - GOOD HOPE, 3003 W GOOD HOPE RD, MILWAUKEE, WI 532091

08/01/2018 07/31/2020AURORA BEHAVIORAL HEALTH - GRAFTON, 975 N. PORT WASHINGTON RD, GRAFTON, WI 530242

08/01/2018 07/31/2020AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER ST, HARTFORD, WI 530272

01/08/2019 07/31/2020AURORA BEHAVIORAL HEALTH - PORT WASHINGTON, 1777 W GRAND AVE, PORT WASHINGTON, WI 53074

2

08/01/2018 07/31/2020AURORA BEHAVIORAL HEALTH - WEST BEND, 205 VALLEY AVENUE, WEST BEND, WI 530952

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Mental Health Program Directory By County, City, and Provider Name

3155AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/29/2016

(414) 454-6450

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeGLENDALE, WI 532176980 N PORT WASHINGTON ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

2367LA CAUSA, INC.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201904/22/2002

(414) 771-7491

(414) [email protected] SCHMID

County: MilwaukeeGLENDALE, WI 532095235 N IRONWOOD ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

1683NORTH SHORE PSYCHOTHERAPY ASSOCIATES

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201807/01/1980

(414) 962-6765

(414) 962-6764nspamilwaukee@northshorepsychoTHERESA HANAMAN

County: MilwaukeeGLENDALE, WI 532175555 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

1836SHOREHAVEN BEHAVIORAL HEALTH INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1983

(414) 540-2171

(414) [email protected] GODEC

County: MilwaukeeGLENDALE, WI 532093900 W BROWN DEER ROAD #200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH INC, 4370 SOUTH 76TH STREET, GREENFIELD, WI 532202

07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH, INC., 2607 N GRANDVIEW BLVD., # 102, WAUKESHA, WI 531882

07/01/2018 06/30/2020SHOREHAVEN BEHAVIORAL HEALTH, INC., 6233 DURAND AVE #F, RACINE, WI 534062

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Mental Health Program Directory By County, City, and Provider Name

3203STRESS MANAGEMENT & MENTAL HEALTH CLINICS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2018

(414) 962-4356

(414) [email protected] BUSHMAN

County: MilwaukeeGLENDALE, WI 532175225 N IRONWOOD RD #102

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

MILWAUKEE

32294TH DIMENSION RECOVERY CENTERS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/11/201810/11/2018

() -

(414) [email protected]

County: MilwaukeeMILWAUKEE, WI 532021216 N PROSPECT AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/11/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/11/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/11/2018 09/30/2020

Services

NO BRANCH LOCATIONS

3119ACCESS RECOVERY MENTAL HEALTH SERVICES (ARMHS)

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/10/2016

(414) 455-1915

(414) [email protected] ADKINS

County: MilwaukeeMILWAUKEE, WI 532152727 WEST CLEVELAND AVE, #204

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 03/01/2018 02/01/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 03/01/2018 02/01/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 03/01/2018 02/01/2019

Services

NO BRANCH LOCATIONS

2844ADKINS COUNSELING SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/22/2009

(414) 393-9773

(414) [email protected] ADKINS

County: MilwaukeeMILWAUKEE, WI 532106001 W CENTER STREET #105

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2406AIDS RESOURCE CENTER OF WISCONSIN

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201910/02/2002

(414) 225-1628

(414) [email protected] LEWIS

County: MilwaukeeMILWAUKEE, WI 53203820 N. PLANKINTON AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2019 12/31/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 01/01/2019 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 01/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 01/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020ARCW APPLETON, 633 C WEST WISCONSIN AVE, APPLETON, WI 549111

01/01/2019 12/31/2020ARCW BELOIT, 136 W. GRAND AVENUE, BELOIT, WI 535111

01/01/2019 12/31/2020ARCW EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI 547021

01/01/2019 12/31/2020ARCW KENOSHA, 1212 - 57TH STREET, KENOSHA, WI 531401

01/01/2019 12/31/2020ARCW LA CROSSE, 811 ROSE ST, LA CROSSE, WI 546031

01/01/2019 12/31/2020ARCW MADISON, 600 WILLIAMS STREET, MADISON, WI 537031

01/01/2019 12/31/2020ARCW WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI 544031

01/01/2019 12/31/2020ARCW GREEN BAY, 445 S ADAMS STREET, GREEN BAY, WI 543012

2875AMRI COUNSELING SERVICES, LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/2009

(866) 719-3024

(414) [email protected] JONES

County: MilwaukeeMILWAUKEE, WI 532164001 WEST CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2018 07/31/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 08/01/2018 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2018 07/31/2020

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 08/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/08/2019 07/31/2020AMRI COUNSELING SERVICES, 3536 W FOND DU LAC AVE, MILWAUKEE, WI 532161

08/01/2018 07/31/2020AMRI COUNSELING SERVICES, 6321 23RD AVENUE, KENOSHA, WI 531431

08/01/2018 07/31/2020MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN AVE, MILWAUKEE, WI 532333

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Mental Health Program Directory By County, City, and Provider Name

2874ANGELS COUNSELING & THERAPY SERVICE

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/01/2009

(414) 455-8362

(414) [email protected] GARBA

County: MilwaukeeMILWAUKEE, WI 532258515 B WEST HAMPTON AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

3146ARUNAOBI INTEGRATED MEDICAL BEHAVIORAL HEALTH CLINIC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/201809/01/201710/06/2016

(414) 810-0587

(414) [email protected] A ANIAKUDO

County: MilwaukeeMILWAUKEE, WI 532105325 W BURLEIGH ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2017 08/31/2018

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 09/01/2017 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2017 08/31/2018

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2017 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2017 08/31/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2017 11/29/2019

Services

NO BRANCH LOCATIONS

3263ASAP - BEHAVIORAL HEALTH

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/19/202012/20/201912/20/2019

() -

(414) 310-9685

VERNON PARTELLO

County: MilwaukeeMILWAUKEE, WI 5321411380 W THEODORE TRECKER WAY

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/20/2019 12/19/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/20/2019 12/19/2020

Services

NO BRANCH LOCATIONS

1215ASCENSION COLUMBIA ST MARYS MILWAUKEE INPATIENT BEHAVIORAL HEALTH

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2015

(414) 585-1924

(414) [email protected] PEERBOLT

County: MilwaukeeMILWAUKEE, WI 532112301 N LAKE DR

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2018 06/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2548ASCENSION SE WI HOSPITAL, INC ST JOSEPH BEHAVIORAL HEALTH

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/27/2004

(414) 874-1177

(414) [email protected] HESS

County: MilwaukeeMILWAUKEE, WI 532105000 W CHAMBERS ST #P210

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2019 10/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

2547ASCENSION ST FRANCIS HOSPITAL, INC BEHAVIORAL HEALTH

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/27/2004

(414) 389-3110

(414) [email protected] HESS

County: MilwaukeeMILWAUKEE, WI 532153237 S 16TH STREET #310

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021ASCENSION COLUMBIA ST MARYS AIRPORT, 4848 S 6TH ST, MILWAUKEE, WI 532211

11/01/2019 10/31/2021ASCENSION FRANKLIN MOB, 9969 S 27TH STREET, FRANKLIN, WI 531321

1839AURORA BEHAVIORAL HEALTH CENTER - SINAI

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202010/01/1987

(414) 454-6450

(414) [email protected] GRAHAM

County: MilwaukeeMILWAUKEE, WI 532331020 N 12TH ST, 401

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1336AURORA FAMILY SERVICE, INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201805/01/1977

(414) 342-5326

(414) 345-4940kevin.o'[email protected] O’BRIEN

County: MilwaukeeMILWAUKEE, WI 532083200 W HIGHLAND BOULEVARD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020CLOCK SHADOW BUILDING, 130 WEST BRUCE ST, MILWAUKEE, WI 532041

Setting Begin/End DatesNon-Certified School Setting(s)08/01/2018 07/31/2020AUDUBON TECHNOLOGY AND COMMUNICATION CENTER, 3300 S 39TH ST, MILWAUKEE, WI 53215

08/01/2018 07/31/2020CROSS TRAINERS ACADEMY, 1516 W CENTER ST, MILWAUKEE, WI 53233

08/01/2018 07/31/2020FOREST HOME ELEMENTARY SCHOOL, 1516 W FOREST HOME, MILWAUKEE, WI 53204

08/01/2018 07/31/2020HOPKINS LLOYD COMMUNITY SCHOOL, 1503 W HOPKINS ST, MILWAUKEE, WI 53206

08/01/2018 07/31/2020KAGEL ELEMENTARY SCHOOL, 1210 W MINERAL ST, MILWAUKEE, WI 53204

08/01/2018 07/31/2020NEXT DOOR FOUNDATION, 2545 N 29THS ST, MILWAUKEE, WI 53210

08/01/2018 07/31/2020WEST SIDE ACADEMY, 1945 N 31ST ST, MILWAUKEE, WI 53208

1096BELL THERAPY INC DAY ONE

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201910/01/1987

(414) 445-5995

(414) [email protected] (CINNY) ADELL

County: MilwaukeeMILWAUKEE, WI 532164065 N 35TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT DHS 61.75 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

1095BELL THERAPY COMMUNITY SUPPORT PROGRAM SOUTH

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201903/03/1997

(414) 210-2222

(414) [email protected] JONES

County: MilwaukeeMILWAUKEE, WI 532164939 WEST FOND DU LAC AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

1093BELL THERAPY INC COMMUNITY SUPPORT PROGRAM NORTH

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201909/01/1990

(414) 871-2552

(414) [email protected] STEPHENS

County: MilwaukeeMILWAUKEE, WI 532164929 W FOND DU LAC AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2456BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/15/2003

(414) 347-0148

(414) [email protected] PERRY

County: MilwaukeeMILWAUKEE, WI 532121849 MARTIN LUTHER KING DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

1132CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201906/01/1981

(414) 771-1674

(414) [email protected] BIBO

County: MilwaukeeMILWAUKEE, WI 532082021 N. 60TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

1177CHILD, ADOLESCENT, FAMILY & MARRIAGE THERAPY ASSOCIATES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/01/1995

(414) 272-3760

(414) [email protected] WILLIAMS

County: MilwaukeeMILWAUKEE, WI 53203161 W WISCONSIN AVE, STE 5190

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

2417CHILDREN'S HOSPITAL OF MILWAUKEE

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/22/2003

(414) 266-3735

(414) [email protected] WOLF

County: MilwaukeeMILWAUKEE, WI 53212619 W WALNUT STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

1179CHILDREN'S HOSPITAL OF WISCONSIN

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201810/01/1978

(414) 266-3735

(414) [email protected] WOLF

County: MilwaukeeMILWAUKEE, WI 532269000 W. WISCONSIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020CHILDREN'S HOSP OF WI CLINICS - MEQUON, 1655 W MEQUON RD, MEQUON, WI 530922

12/01/2018 11/30/2020CHILDREN'S HOSP OF WI CLINICS-NEW BERLIN, 4855 S MOORLAND ROAD, NEW BERLIN, WI 531512

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Mental Health Program Directory By County, City, and Provider Name

1187CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/1983

(414) 292-4182

(414) [email protected] SCHUTZ

County: MilwaukeeMILWAUKEE, WI 53214620 S 76TH SREET #240

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021CHILDREN'S SERV SOC OF WI - WELL-BEING SUMMIT, 6737 W WASHINGTON ST, MILWAUKEE, WI

532141

01/01/2020 12/31/2021CHILDREN'S SERVICE SOCIETY OF WI, 620 S 76TH ST, STE 120, MILWAUKEE, WI 532142

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2020 12/31/2021ATWATER ELEMENTARY, 2100 E CAPITOL DR, MILWAUKEE, WI 53211

01/01/2020 12/31/2021AUER AVENUE SCHOOL, 2319 W AUER AVE, MILWAUKEE, WI 53206

01/01/2020 12/31/2021DR MARTIN LUTHER KING ELEMENTARY, 3275 N 3RD ST, MILWAUKEE, WI 53212

01/01/2020 12/31/2021GREATER HOLY TEMPLE CHRISTIAN ACADEMY, 5575 N 76TH ST, MILWAUKEE, WI 53218

01/01/2020 12/31/2021JAMES MADISON ACADEMIC CAMPUS, 8135 W FLORIST AVE, MILWAUKEE, WI 53218

01/01/2020 12/31/2021LAKE BLUFF ELEMENTARY, 1600 E LAKE BLUFF BLVD, MILWAUKEE, WI 53211

01/01/2020 12/31/2021MILWAUKEE SCHOOL OF LANGUAGES, 8400 W BURLEIGH ST, MILWAUKEE, WI 53208

01/01/2020 12/31/2021RIVERWEST ELEMENTARY SCHOOL, 2765 N FRATNEY ST, MILWAUKEE, WI 53212

01/01/2020 12/31/2021SHOREWOOD HIGH SCHOOL, 1701 E CAPITOL DR, MILWAUKEE, WI 53211

01/01/2020 12/31/2021SHOREWOOD INTERMEDIATE, 3830 N MORRIS BLVD, MILWAUKEE, WI 53211

1870COLUMBIA ST. MARY'S BEHAVIORAL MEDICINE - MILWAUKEE

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/201901/01/201806/01/1981

(414) 585-1924

(414) [email protected] PEERBOLT

County: MilwaukeeMILWAUKEE, WI 532112323 N LAKE DRIVE, 7TH FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2018 12/31/2019

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2018 12/31/2018

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2018 12/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2018 12/31/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2018 12/31/2019

Services

NO BRANCH LOCATIONS

2373COMMUNITY RELATIONS SOCIAL DEVELOPMENT COMMISSION (SDC)

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202002/22/201904/29/2002

(414) 906-2719

(414) [email protected] SAMPTON

County: MilwaukeeMILWAUKEE, WI 532051730 W NORTH AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/22/2019 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/22/2019 04/30/2020

Services

NO BRANCH LOCATIONS

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1233COMPREHENSIVE CLINICAL & CONSULTING SERVICES INC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201901/01/1982

(414) 352-7625

(414) [email protected] SCHULHAUSER

County: MilwaukeeMILWAUKEE, WI 532177161 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021CCCS AT ADVANCED PAIN MANAGEMENT, 1616 NORTH CASALOMA DR, APPLETON, WI 549131

09/01/2019 08/31/2021CCCS AT ADVANCED PAIN MANAGEMENT, 2595 DEVELOPMENT DRIVE, GREEN BAY, WI 543111

09/01/2019 08/31/2021CCCS AT ADVANCED PAIN MANAGEMENT, 9697 ST CATHERINE'S DRIVE STE 101, PLEASANT PRAIRIE, WI 53158

1

09/01/2019 08/31/2021COMPREHENSIVE CLINICAL & CONSULTING SVS, 4131 W LOOMIS RD SUITE 240, GREENFIELD, WI 53221

2

3236CREATIVE COUNSELING OF MILWAUKEE

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/24/201810/24/2018

(608) 305-2626

(414) [email protected] STONE

County: MilwaukeeMILWAUKEE, WI 532092266 N PROSPECT AVE #304

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/24/2018 09/30/2020

Services

NO BRANCH LOCATIONS

3153CROSSROADS COGNITIVE BEHAVIORAL SERVICES

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201910/01/2016

(414) 562-6361

(414) [email protected] MCCLENDON

County: MilwaukeeMILWAUKEE, WI 532052454 WEST LISBON AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

2953EMPATHETIC COUNSELING SERVICES INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2011

(414) 875-2355

(414) [email protected] BROUGHTON LEWIS

County: MilwaukeeMILWAUKEE, WI 532166815 WEST CAPITOL DRIVE #311

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020EMPATHETIC COUNSELING SERVICES SOUTH, 610 WEST LINCOLN AVE SUITE 2C, MILWAUKEE, WI

532042

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2473FOKUS FAMILY SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2014

(414) 264-4218

(414) [email protected] COLLINS

County: MilwaukeeMILWAUKEE, WI 532122821 N VEL R PHILLIPS AVE, #123

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

2785FORWARD CHOICES LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/14/2008

(414) 442-1775

(414) [email protected] WALLNER

County: MilwaukeeMILWAUKEE, WI 532106040 W LISBON AVENUE, #103

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

2479GATEWAY TO CHANGE

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201810/29/2003

(414) 442-2167

(414) [email protected] HAMPTON

County: MilwaukeeMILWAUKEE, WI 532062319 W. CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2018 11/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

3040GERALD L IGNACE INDIAN HEALTH CENTER

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/01/2014

(414) 649-2719

(414) [email protected] BRAAKSMA

County: MilwaukeeMILWAUKEE, WI 53204930 W HISTORIC MITCHELL ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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2803GRO FAMILY SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/28/2008

(414) 395-4716

(414) [email protected] OWENS

County: MilwaukeeMILWAUKEE, WI 532102436 NORTH 50TH STREET

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2101GUEST HOUSE COUNSELING CLINIC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201907/15/1992

(414) 345-3258

(414) [email protected] VAREKA

County: MilwaukeeMILWAUKEE, WI 532051216 N. 13TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

2174HORIZON HEALTHCARE INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201911/01/1999

(414) 762-9727

(414) [email protected] SANCHEZ

County: MilwaukeeMILWAUKEE, WI 532074650 S HOWELL AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021HORIZON HEALTHCARE INC, 1231 W HISTORIC MITCHELL ST, MILWAUKEE, WI 532042

12/12/2019 11/30/2021HORIZON HEALTHCARE INC, 2819 W HIGHLAND BLVD, MILWAUKEE, WI 532082

12/01/2019 11/30/2021HORIZON HEALTHCARE INC, 3410 80TH STREET, KENOSHA, WI 531422

12/01/2019 11/30/2021HORIZON HEALTHCARE INC, 5408 W BURLEIGH ST, MILWAUKEE, WI 532102

12/01/2019 11/30/2021HORIZON HEALTHCARE INC, 5626 NO 91ST ST STE 206, MILWAUKEE, WI 532252

12/01/2019 11/30/2021HORIZON HEALTHCARE INC, 835 WISCONSIN AVE, RACINE, WI 534032

3087INNER CITY BEHAVIORAL SERVICES, LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2015

(414) 444-2732

(414) [email protected] TRIPP

County: MilwaukeeMILWAUKEE, WI 532083341 WEST NORTH AVENUE #101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

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3261INTEGRATIVE PSYCHE LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/202001/01/2020

(414) 545-4454

(414) [email protected] KLEPP, PSY.D.

County: MilwaukeeMILWAUKEE, WI 5322710150 W NATIONAL AVE STE 390

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2020

Services

NO BRANCH LOCATIONS

1450JEWISH FAMILY SERVICES

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/1979

(414) 390-5808

(414) [email protected] DAVID

County: MilwaukeeMILWAUKEE, WI 532021300 N JACKSON STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020JEWISH FAMILY SVS - BRADLEY CROSSING, 4375 WEST BRADLEY ROAD, BROWN DEER, WI 532231

06/01/2018 05/31/2020SOJOURNER FAMILY PEACE CTR, 619 WEST WALNUT ST, MILWAUKEE, WI 532121

Setting Begin/End DatesNon-Certified School Setting(s)06/01/2018 05/31/2020JEWISH FAMILY SVS BROWN DEER ELEMENTARY, 5757 WEST DEAN ROAD, BROWN DEER, WI

5322306/01/2018 05/31/2020JEWISH FAMILY SVS CENTRAL CITY CYBERSCHOOL, 4301 NORTH 44TH ST, MILWAUKEE, WI 53216

06/01/2018 05/31/2020JEWISH FAMILY SVS-BROWN DEER MIDDLE/HIGH SCHOOL, 8060 NORTH 60TH STREET, MILWAUKEE, WI 53223

1876LAD LAKE - ST ROSE CENTER

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201807/05/1985

(414) 466-0730

(414) [email protected] LOWE

County: MilwaukeeMILWAUKEE, WI 532223801 N. 88TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020LAD LAKE, INC. DOUSMAN, W350 - S1401 WATERVILLE ROAD, DOUSMAN, WI 531181

3045LIFE CHANGING MINISTRIES INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/16/2014

(414) 755-0698

(414) [email protected] THOMPSON

County: MilwaukeeMILWAUKEE, WI 532051134 W NORTH AVE, 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/07/2019 06/30/2020LIFE CHANGING MINISTRIES, 2365 S 13TH ST, MILWAUKEE, WI 532052

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1509LIGHTHOUSE CLINIC, LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/1990

(414) 964-4816

(414) [email protected] RENNER

County: MilwaukeeMILWAUKEE, WI 532112524 E WEBSTER PLACE #203

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2018 01/31/2020LIGHTHOUSE CLINIC, 11803 W NORTH AVENUE, #207, MILWAUKEE, WI 532261

3039LOCKETT ENTERPRISES, LLC BEHAVIORAL HEALTH SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201907/29/2014

(414) 223-3817

(414) [email protected] LOCKETT JR.

County: MilwaukeeMILWAUKEE, WI 532021845 NORTH FARWELL AVE SUITE 301

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

3223M & S CLINICAL SERVICES, INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/28/2018

(414) 263-2270

(414) [email protected] FOSSIE

County: MilwaukeeMILWAUKEE, WI 532122821 N VEL R PHILLIPS AVE, STE 210

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

3213MANNA BEHAVIORAL SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/2018

(414) 585-0115

(414) [email protected] L RICHARDSON

County: MilwaukeeMILWAUKEE, WI 532122821 N 4TH STREET #223

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

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3062MATTERS OF THE SPIRIT, LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201901/01/2015

(414) 488-2969

(414) [email protected] TINA SANFORD

County: MilwaukeeMILWAUKEE, WI 532166815 WEST CAPITOL DRIVE, SUITE 112

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

1580MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201907/01/1996

(414) 955-6295

(414) [email protected] HUBERTY

County: MilwaukeeMILWAUKEE, WI 532261155 N MAYFAIR ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 02/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2225MD THERAPY

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/05/2000

(414) 466-3206

(414) [email protected] (MIKE) DALE

County: MilwaukeeMILWAUKEE, WI 532166815 W CAPITOL DRIVE, #208

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

2172META HOUSE, INC.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201911/24/1999

(414) 962-2305

(414) [email protected] JOYCE

County: MilwaukeeMILWAUKEE, WI 532122625 N WEIL STREET

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3187MHA - WI WELLNESS CLINIC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201811/15/2017

(414) 276-3124

(414) 276-3122sa'[email protected]'AIRE SALTON

County: MilwaukeeMILWAUKEE, WI 53204600 W VIRGINIA ST SUITE #502

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2019 11/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1933MILWAUKEE CENTER FOR INDEPENDANCE DBA WHOLE HEALTH CLINICAL GROUP

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201909/01/1985

(414) 615-0627

(414) [email protected] MCGUIRE

County: MilwaukeeMILWAUKEE, WI 53214932 S 60TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2019 05/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 06/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021CRISIS RESOURCE CENTER, 2057 S 14TH STREET, MILWAUKEE, WI 532041

06/01/2019 05/31/2021CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI 532181

06/01/2019 05/31/2021NEXDAY, 3333 SOUTH HOWELL AVE, MILWAUKEE, WI 532071

1632MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201908/01/1977

(414) 257-8119

(414) 257-7473jennifer.bergersen@milwaukeecounJENNIFER BERGERSEN

County: MilwaukeeMILWAUKEE, WI 532269455 WATERTOWN PLANK ROAD

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

1634MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION CHILDREN'S MOBILE CRISIS TEAM

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/1996

(414) 257-8126

(414) 257-7385latoya.johnson@milwaukeecountywLATOYA JOHNSON

County: MilwaukeeMILWAUKEE, WI 532269455 WATERTOWN PLANK ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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3037MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/2014

(414) 545-4242

(414) 257-8085Jennifer.Wittwer@MilwaukeeCountyJENNIFER WITTWER

County: MilwaukeeMILWAUKEE, WI 532269455 WEST WATERTOWN PLANK ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, 6737 W WASHINGTON ST #1325, WEST ALLIS,

WI 532142

09/01/2019 08/31/2021ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, 10045 W LISBON AVENUE, MILWAUKEE, WI 53222

2

09/01/2019 08/31/2021BELL THERAPY, INC, 3090 N 53RD STREET, MILWAUKEE, WI 532102

09/01/2019 08/31/2021JEWISH FAMILY SERVICES, INC., 1300 N JACKSON ST, MILWAUKEE, WI 532022

09/01/2019 08/31/2021JUSTICE POINT, INC, 111 W PLEASANT ST STE #202, MILWAUKEE, WI 532122

09/01/2019 08/31/2021LA CAUSA, INC, 5235 N IRONWOOD RD, GLENDALE, WI 532172

09/01/2019 08/31/2021MCFI DBA WHOLE HEALTH GROUP, 932 SOUTH 60TH STREET, MILWAUKEE, WI 532142

09/01/2019 08/31/2021MILWAUKEE MENTAL HEALTH ASSOCIATES, INC, 3975 N 68TH STREET, MILWAUKEE, WI 532162

09/01/2019 08/31/2021OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI 532062

09/01/2019 08/31/2021PATHFINDERS MILWAUKEE, INC, 4200 N HOLTON ST, MILWAUKEE, WI 532122

09/04/2019 08/31/2021PROFESSIONAL SERVICES GROUP INC, 1205 S 70TH ST, #301, WEST ALLIS, WI 532142

09/01/2019 08/31/2021PROJECT ACCESS, INC, 823 S 60TH ST, MILWAUKEE, WI 532142

09/01/2019 08/31/2021SAINT A, 8901 W CAPITOL DR, MILWAUKEE, WI 532222

09/01/2019 08/31/2021THE GUEST HOUSE OF MILWAUKEE, 1216 N 13TH STREET, MILWAUKEE, WI 532052

09/01/2019 08/31/2021WISCONSIN COMMUNITY SERVICES, 3732 W WISCONSIN AVE #330, MILWAUKEE, WI 532082

1642MILWAUKEE HEALTH SERVICES, INC. DBA BEHAVIORAL HEALTH SERVICES CENTER

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/1994

(414) 464-6472

(414) [email protected] MANN

County: MilwaukeeMILWAUKEE, WI 532188200 W SILVER SPRING DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 04/30/2021MARTIN LUTHER KING-HERITAGE HEALTH CENTER, 2555 N MARTIN LUTHER KING JR DRIVE,

MILWAUKEE, WI 532122

1645MILWAUKEE MENTAL HEALTH ASSOCIATES COMMUNITY SUPPORT PROGRAM

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201902/18/1997

(414) 873-4990

(414) [email protected] HARRIS

County: MilwaukeeMILWAUKEE, WI 532163975 N 68TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021MILWAUKEE MENTAL HEALTH ASSOCIATES, INC - NATIONAL, 3073 S CHASE AVE, SUITE 100,

MILWAUKEE, WI 532072

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Mental Health Program Directory By County, City, and Provider Name

2891MINDSTAR COUNSELING, LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2009

(414) 435-0543

(414) [email protected] PATTERSONBIDDLE

County: MilwaukeeMILWAUKEE, WI 532227900 W BURLEIGH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 12/01/2018 11/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1794MWCCA BEHAVIORAL HEALTH CLINIC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201902/01/1988

(414) 270-3793

(414) [email protected] LOCKETT JR

County: MilwaukeeMILWAUKEE, WI 532164906 W FOND DU LAC AVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2019 06/30/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

2930NEW CHOICES, LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/14/2010

(414) 444-8432

(414) [email protected] WILLIAMS

County: MilwaukeeMILWAUKEE, WI 532123565 N MARTIN LUTHER KING DR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

2413OMNI ENRICHMENT, INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201902/01/2003

(414) 455-3292

(414) [email protected] TRIPP

County: MilwaukeeMILWAUKEE, WI 532083020 W. VLIET STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1777OUTREACH COMMUNITY HEALTH CENTER INC RECOVERY CSP

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/17/1996

(414) 374-7917

(414) [email protected] GABRIEL

County: MilwaukeeMILWAUKEE, WI 53206711 W CAPITOL DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

2246OUTREACH COMMUNITY HEALTH CENTERS INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/01/2000

(414) 962-3861

(414) [email protected] SANDERS

County: MilwaukeeMILWAUKEE, WI 53212210 W CAPITOL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021OUTREACH COMMUMITY HEALTH CENTERS, 9120 W HAMPTON AVE, MILWAUKEE, WI 532252

08/01/2019 07/31/2021OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI 532062

2990PARADIGM ENRICHMENT SERVICES, INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/25/2013

(414) 393-1155

(414) [email protected] JACKSON II

County: MilwaukeeMILWAUKEE, WI 532164222 W CAPITOL DR, 1ST FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

1910PATHFINDERS MILWAUKEE, INC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201804/01/2011

(414) 964-0102

(414) [email protected] STAUDACHER

County: MilwaukeeMILWAUKEE, WI 532124200 N HOLTON STREET, #400

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

2923PENFIELD CHILDREN'S CENTER

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/2010

(414) 344-7739

(414) [email protected] ROTOLO

County: MilwaukeeMILWAUKEE, WI 53233833 N 26TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

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2796POSITIVE OUTLOOK CLINICAL SERVICES LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/2008

(414) 355-5467

(414) [email protected] HANSEN

County: MilwaukeeMILWAUKEE, WI 532166815 W CAPITOL DR, SUITE 304

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/01/2018 07/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

1751PROJECT ACCESS, INC. CSP

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201912/20/1995

(414) 456-1655

(414) [email protected] ROGER ZHONG

County: MilwaukeeMILWAUKEE, WI 53214823 S 60TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

1445PSYCARE-MILWAUKEE LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/04/2007

(414) 271-2335

(414) [email protected] A GARLAND

County: MilwaukeeMILWAUKEE, WI 53203633 W. WISCONSIN AVENUE, #1810

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

2118RAVENSWOOD CLINIC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201906/23/1999

(414) 224-8112

(414) [email protected] F. WERTH, JR.

County: MilwaukeeMILWAUKEE, WI 532022266 N. PROSPECT AVENUE, #326

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

1792RENEW COUNSELING SERVICES

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201904/01/1985

(414) 727-8730

(414) [email protected] CROATT

County: MilwaukeeMILWAUKEE, WI 532041225 W. MITCHELL STREET, #223

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3205SAINT A

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/04/2018

(414) 463-2770

(414) [email protected] PAHLAVAN

County: MilwaukeeMILWAUKEE, WI 532228901 W CAPITOL DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/12/2019 05/31/2021ARROWHEAD HIGH SCHOOL, 700 NORTH AVE, HARTLAND, WI 530293

12/18/2019 05/31/2021BLAKEWOOD ELEMENTARY SCHOOL, 3501 BLAKEWOOD AVE, SOUTH MILWAUKEE, WI 531723

12/12/2019 05/31/2021CARMEN NORTHWEST CAMPUS, 5496 NORTH 72ND ST, MILWAUKEE, WI 532183

12/18/2019 05/31/2021E W LUTHER ELEMETARY, 718 HAWTHORNE AVE, SOUTH MILWAUKEE, WI 531723

06/01/2019 05/31/2021FRANK LLOYD WRIGHT INT, 9501 W CLEVELAND AVE, WEST ALLIS, WI 532273

06/01/2019 05/31/2021FRANKLIN ELEMENTARY, 2060 86TH ST, WEST ALLIS, WI 532273

06/01/2019 05/31/2021HOOVER ELEMENTARY, 12705 W EUCLID AVE, NEW BERLIN, WI 531513

06/01/2019 05/31/2021HORACE MANN ELEMENTARY, 6213 W LAPHAM ST, WEST ALLIS, WI 532143

06/01/2019 05/31/2021HORIZON ELEMENTARY SCHOOL, 458 LAKE ST, PEWAUKEE, WI 530723

12/18/2019 05/31/2021LAKEVIEW ELEMENTARY, 711 MARION AVE, SOUTH MILWAUKEE, WI 531723

06/01/2019 05/31/2021LONGFELLOW ELEMENTARY, 2211 S 60TH ST, WEST ALLIS, WI 532193

12/18/2019 05/31/2021LONGFELLOW MIDDLE SCHOOL, 7600 W NORTH AVE, MILWAUKEE, WI 532133

06/01/2019 05/31/2021PEWAUKEE HIGH SCHOOL, 510 LAKE ST, PEWAUKEE, WI 530723

06/01/2019 05/31/2021PEWAUKEE LAKE ELEMENTARY, 436 LAKE ST, PEWAUKEE, WI 530723

12/18/2019 05/31/2021RAWSON ELEMENTARY, 1410 RAWSON AVE, SOUTH MILWAUKEE, WI 531723

12/12/2019 05/31/2021RIVERSIDE ELEMENTARY, W153N8681 MARGARET RD, MENOMONEE FALLS, WI 530513

12/18/2019 05/31/2021SEEDS OF HEALTH ELEMENTARY, 1445 S 32ND ST, MILWAUKEE, WI 532153

12/12/2019 05/31/2021SOUTH MILWAUKEE HIGH SCHOOL, 801 15TH AVE, SOUTH MILWAUKEE, WI 531723

12/12/2019 05/31/2021SOUTH MILWAUKEE MIDDLE, 1001 15TH AVE, SOUTH MILWAUKEE, WI 531723

12/12/2019 05/31/2021VALLEY VIEW ELEMENTARY, W180 N8130 TOWN HALL RD, MENOMONEE FALLS, WI 530513

06/01/2019 05/31/2021WEST MILWAUKEE INT, 5104 GREENFIELD AVE, WEST ALLIS, WI 532143

06/01/2019 05/31/2021WILSON ELEMENTARY, 8710 W ORCHARD ST, WEST ALLIS, WI 532143

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2495SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/14/2004

(414) 247-0816

(414) [email protected] SSEMPIJJA

County: MilwaukeeMILWAUKEE, WI 532091720 W FLORIST AVENUE #125

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020SEBASTIAN FAMILY PSYCHOLOGY, 2745 W LAYTON AVE, STE 203, MILWAUKEE, WI 532211

01/01/2019 12/31/2020AUDUBON TECHNOLOGY & COMMUNICATION CENTER, 3300 S 39TH ST, MILWAUKEE, WI 532153

01/01/2019 12/31/2020BENJAMIN FRANKLIN SCHOOL, 2308 W NASH ST, MILWAUKEE, WI 532063

01/01/2019 12/31/2020BETHUNE ACADEMY, 1535 N 35TH ST, MILWAUKEE, WI 532083

01/01/2019 12/31/2020HENRY DAVID THOREAU, 7878 N 60TH ST, MILWAUKEE, WI 532233

01/01/2019 12/31/2020KEEFE AVENUE ELEMENTARY SCHOOL, 1618 W KEEFE AVE, MILWAUKEE, WI 532063

01/01/2019 12/31/2020MILW COLLEGE PREP LLOYD ST, 1228 W LLOYD ST, MILWAUKEE, WI 532053

01/01/2019 12/31/2020OLIVER WENDALL HOLMES SCHOOL, 2463 N BUFFUM ST, MILWAUKEE, WI 532123

01/01/2019 12/31/2020SHERMAN MULTICULTURAL ARTS SCHOOL, 5110 W LOCUST ST, MILWAUKEE, WI 532103

01/01/2019 12/31/2020ST CATHERINE SCHOOL, 2647 N 51ST ST, MILWAUKEE, WI 532103

1011SIXTEENTH STREET BEHAVIORAL HEALTH CENTER

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/15/1997

(414) 383-5597

(414) [email protected] PEREZ

County: MilwaukeeMILWAUKEE, WI 532041032 S CESAR E CHAVEZ DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020PARKWAY CLINIC, 2906 S 20TH STREET, MILWAUKEE, WI 532151

11/01/2018 10/31/2020WAUKESHA COMMUNITY HEALTH CENTER, 309 E. NORTH STREET, WAUKESHA, WI 531881

3199SIXTEENTH STREET COMMUNITY HEALTH CENTERS - LAYTON

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2018

(414) 383-5597

(414) [email protected] ELENA PEREZ, PHD

County: MilwaukeeMILWAUKEE, WI 532214570 S 27TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3201SMILE INC MENTAL HEALTH AND AODA OUTPATIENT CLINIC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/02/2018

(414) 249-3312

(414) [email protected] VEASEY

County: MilwaukeeMILWAUKEE, WI 532164222 W CAPITOL DR #308

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 04/01/2019 03/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

1322ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201901/01/1991

(414) 219-9040

(414) [email protected] UNDERWOOD

County: MilwaukeeMILWAUKEE, WI 532184757 N. 76TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 09/05/2019 01/31/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2019 01/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021ST CHARLES - FAMILY DEVELOPMENT CENTER, 151 S 84TH STREET, MILWAUKEE, WI 532141

2690ST. LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201908/30/2006

(414) 454-6450

(414) [email protected] SLOMSKI

County: MilwaukeeMILWAUKEE, WI 532152900 W OKLAHOMA AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

2921THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/19/2010

(414) 255-3451

(414) 831-4500toddcampbell@thebridgehealthclinicTODD CAMPBELL

County: MilwaukeeMILWAUKEE, WI 532185401 N 76TH STREET #100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021THE BRIDGE HEALTH CLINICS & RC, 9401 W BELOIT RD, #105, MILWAUKEE, WI 532272

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2634THE HUMAN DEVELOPMENT CENTER, INC.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/25/2006

(414) 449-9912

(414) [email protected] PELDO

County: MilwaukeeMILWAUKEE, WI 532186833 WEST FOND DU LAC AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

2944THE POWER OF CHANGE INC BEHAVIORAL SERVICES

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201907/01/2011

(414) 374-8181

(414) [email protected] ARMON-BENT

County: MilwaukeeMILWAUKEE, WI 532122821 N VEL R PHILLIPS AVE STE #131

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

1657UNITED COMMUNITY CENTER

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201805/01/1980

(414) 647-8602

(414) [email protected] A. RUIZ

County: MilwaukeeMILWAUKEE, WI 532041100 S 6TH STREET, 3RD FLOOR

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/01/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

2004WILLOWGLEN ACADEMY OUTPATIENT CLINIC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/1992

(414) 527-6971

(414) [email protected] KUMMROW

County: MilwaukeeMILWAUKEE, WI 532164065 NORTH 35TH STREET STE # N100

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020WILLOWGLEN ACADEMY - DAY ONE EAST, 6414 W. FOND DU LAC AVE, MILWAUKEE, WI 532181

08/01/2018 07/31/2020WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI 532162

08/01/2018 07/31/2020WILLOWGLEN ACADEMY, 5555 NORTH 51ST BLVD, MILWAUKEE, WI 532182

08/01/2018 07/31/2020WILLOWGLEN ACADEMY - ARROWHEAD UNION HS, 700 NORTH AVE, HARTLAND, WI 530293

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Mental Health Program Directory By County, City, and Provider Name

1995WISCONSIN COMMUNITY SERVICES OUTPATIENT MENTAL HEALTH PROGRAM

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201906/01/1977

(414) 344-2191

(414) [email protected] DUBLINSKI

County: MilwaukeeMILWAUKEE, WI 532083734 W WISCONSIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

1955WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIAL

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201806/01/1986

(414) 226-0351

(414) [email protected] CARROLL

County: MilwaukeeMILWAUKEE, WI 532083732 W WISCONSIN AVE STE 200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

1993WISCONSIN COMMUNITY SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/01/1995

(414) 334-2191

(414) [email protected] COLLYARD

County: MilwaukeeMILWAUKEE, WI 532083734 W WISCONSIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

3149WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202001/01/201911/08/2016

(262) 345-5531

(262) [email protected] SEMMANN

County: MilwaukeeMILWAUKEE, WI 532122669 NORTH RICHARDS STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 01/01/2019 10/31/2020

Services

NO BRANCH LOCATIONS

SHOREWOOD

2951BEHRENS PSYCHOTHERAPY SERVICES, LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2011

(262) 229-4744

(262) [email protected] BEHRENS

County: MilwaukeeSHOREWOOD, WI 532112321 E CAPITOL DRIVE, #400

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WAUWATOSA

3158ABG WELLNESS GROUP INC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2016

(414) 973-2090

(414) [email protected] LIPSKI

County: MilwaukeeWAUWATOSA, WI 532137332 W STATE ST, SUITE 6

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021PARK PLACE OFFICE, 11414 W PARK PLACE STE 202, MILWAUKEE, WI 532241

1033ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201911/20/1997

(414) 358-7158

(414) [email protected] DREXLER

County: MilwaukeeWAUWATOSA, WI 5322210045 W LISBON AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021ALTERNATIVES IN PSYCH CONSULT, 6737 W WASHINGTON ST SUITE 1300, WEST ALLIS, WI 532142

2518AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/31/2004

(414) 454-6450

(414) [email protected] BAHR

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

1647AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201809/01/1979

(414) 454-6450

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE BLDG 4

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 08/01/2018 07/31/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 08/01/2018 07/31/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2018 07/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3140AURORA PSYCHIATRIC HOSPITAL INC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/01/2016

(414) 454-6662

(414) [email protected] SURFUS-LEWISTON

County: MilwaukeeWAUWATOSA, WI 532131220 DEWEY AVENUE BLDG 7

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2019 07/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 3 DHS 40.11(2)(C) 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

2199CHILDYNAMICS, LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/15/2000

(414) 258-4328

(414) [email protected] ISABELLA SARDAS

County: MilwaukeeWAUWATOSA, WI 5322611904 W. NORTH AVENUE, #110

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1516LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/1978

(414) 536-8348

(414) [email protected] L RAYBURN

County: MilwaukeeWAUWATOSA, WI 532223800 N MAYFAIR ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 15 E SAWYER, RICE LAKE, WI 548681

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI 549231

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 210 S ONEIDA ST, GREEN BAY, WI 543031

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 2833 RARITAN, FITCHBURG, WI 537111

04/25/2019 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 2940 MINERAL POINT AVE, JANESVILLE, WI 53548

1

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 300 BROADWAY DR, SUN PRAIRIE, WI 535901

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 324 S ANDREWS ST, SHAWANO, WI 541661

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 345 NORTH PINE ST, REEDSBURG, WI 539591

02/11/2019 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 400 N SAWYER ST, OSHKOSH, WI 549021

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4850 S LAKE DRIVE, CUDAHY, WI 531101

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI 530141

04/01/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG ST, PORTAGE, WI 539011

09/05/2018 03/31/2020LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E1887 KING ROAD, WAUPACA, WI 549811

Setting Begin/End DatesNon-Certified School Setting(s)02/05/2019 03/31/2020ATONEMENT LUTHERAN SCHOOL, 4224 W RUBY AVE, MILWAUKEE, WI 53209

04/01/2018 03/31/2020BEAUTIFUL SAVIOR LUTHERAN SCHOOL, 1205 EAST AVE, WAUKESHA, WI 53186

02/05/2019 03/31/2020BROWN DEER ELEMENTARY SCHOOL, 5757 W DEAN RD, BROWN DEER, WI 53223

02/05/2019 03/31/2020BROWN DEER MIDDLE/HIGH SCHOOL, 8200 N 60TH ST, BROWN DEER, WI 53223

02/05/2019 03/31/2020CONCORDIA LUTHERAN SCHOOL, 8500 DURAND AVE, STURTEVANT, WI 53177

04/01/2018 03/31/2020GRACE LUTHERAN SCHOOL, N87W16173 KENWOOD BLVD, MENOMONEE FALLS, WI 53051

02/05/2019 03/31/2020GRANVILLE LUTHERAN SCHOOL (LUMIN), 8242 N GRANVILLE DR, MILWAUKEE, WI 53224

02/05/2019 03/31/2020MT CALVARY LUTHERAN SCHOOL, 2850 N 53RD ST, MILWAUKEE, WI 53210

02/07/2019 03/31/2020NORTHWEST LUTHERAN SCHOOL, 4119 N 81ST ST, MILWAUKEE, WI 53222

04/01/2018 03/31/2020OUR REDEEMER LUTHERAN SCHOOL, 10025 W NORTH AVE, WAUWATOSA, WI 53226

02/05/2019 03/31/2020PILGRIM LUTHERAN SCHOOL (LUMIN), 6717 W CENTER ST, WAUWATOSA, WI 53210

04/01/2018 03/31/2020RENAISSANCE LUTHERAN SCHOOL - TAYLOR (LUMIN), 6150 TAYLOR AVE, RACINE, WI 53403

04/01/2018 03/31/2020RENAISSANCE LUTHERAN SCHOOL - VILLA, 1510 VILLA ST, RACINE, WI 53403

3101RISE YOUTH & FAMILY SERVICES, LLC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/20/2015

(414) 433-1919

(414) [email protected] NEWMAN

County: MilwaukeeWAUWATOSA, WI 532268500 W NORTH AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3175SAQH

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202008/01/201909/25/2017

(414) 434-4248

(414) 299-3872syed.hussaini@saqhbehavioralhealtSYED HUSSAINI

County: MilwaukeeWAUWATOSA, WI 532262222 N MAYFAIR ROAD #200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/28/2019 08/31/2020SAQH SOUTH, 8825 HOWELL AVE #201, OAK CREEK, WI 531542

08/01/2019 08/31/2020SAQH WEST, 13000 W BLUEMOUND RD, #201, ELM GROVE, WI 531222

2805THE REDI CLINIC OF WAUWATOSA, SC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/09/2008

(414) 727-4690

(414) [email protected] DRAJKOWSKI

County: MilwaukeeWAUWATOSA, WI 532262500 NORTH MAYFAIR ROAD #600

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2318WEST GROVE CLINIC

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/22/2001

(414) 810-4845

(414) [email protected] WEST

County: MilwaukeeWAUWATOSA, WI 5322210012 WEST CAPITOL DRIVE #101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/08/2019 06/30/2020WEST GROVE CLINIC - KENOSHA, 1400 75TH ST, KENOSHA, WI 531431

07/01/2019 06/30/2020WEST GROVE CLINIC - OAK CREEK, 6419 S HOWELL AVE, OAK CREEK, WI 531541

07/01/2019 06/30/2020WEST GROVE CLINIC, 7310 W WELLS ST, WAUWATOSA, WI 532131

WEST ALLIS

2397AURORA BEHAVIORAL HEALTH CENTER - WEST ALLIS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201907/12/2002

(414) 454-6450

(414) [email protected] CHRISTMAN

County: MilwaukeeWEST ALLIS, WI 532272424 S 90TH STREET SUITE 502

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3026MAPLEGROVE TREATMENT CENTER

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202001/01/201904/08/2014

() -

(414) [email protected] TAKAMURA

County: MilwaukeeWEST ALLIS, WI 532141455 S 97TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 10/31/2020

Services

NO BRANCH LOCATIONS

2125MILWAUKEE CENTER FOR INDEPENDENCE DBA WHOLE HEALTH CLINICAL GROUP

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201909/01/1985

(414) 615-0627

(414) [email protected] LEAHY

County: MilwaukeeWEST ALLIS, WI 53214932 SOUTH 60TH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

3206MIRACLE COUNSELING AND LIFE COACHING LLC

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/05/201906/03/2018

(414) 979-6449

(414) [email protected] CABRERA

County: MilwaukeeWEST ALLIS, WI 532278440 W NATIONAL AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/05/2019 05/31/2021

Services

NO BRANCH LOCATIONS

3239ROGERS BEHAVIORAL HEALTH - LINCOLN CENTER II

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201908/21/2018

(262) 303-2007

(414) [email protected] SCHULTZ

County: MilwaukeeWEST ALLIS, WI 532272400 S 102ND ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2019 08/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3032ROGERS MEMORIAL HOSPITAL

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2014

(920) 843-5685

(414) [email protected] SCHULTZ

County: MilwaukeeWEST ALLIS, WI 532272448 SOUTH 102ND ST RM #200

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2019 04/30/2021

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 05/01/2019 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 05/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2019 04/30/2021

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 05/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2214ROGERS MEMORIAL HOSPITAL - MILWAUKEE

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2000

(414) 203-4577

(414) [email protected] SCHULTZ

County: MilwaukeeWEST ALLIS, WI 5322711101 W. LINCOLN AVENUE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 08/17/2018

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 08/17/2018

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 05/01/2018 08/17/2018

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B)

05/01/2018 08/17/2018

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

3204STRESS MANAGEMENT & MENTAL HEALTH CLINICS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/2018

(414) 329-7010

(414) [email protected] BUSHMAN

County: MilwaukeeWEST ALLIS, WI 5322710201 W LINCOLN AVE #308

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

MONROECASHTON

2804SCENIC BLUFFS COMMUNITY HEALTH CENTERS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/28/2008

(608) 654-5120

(608) [email protected] TURNER

County: MonroeCASHTON, WI 54619238 FRONT STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 200 W. NORTH STREET, NORWALK, WI 546481

07/01/2018 06/30/2020SCENIC BLUFFS COMMUNITY HEALTH CENTERS, 217 N BLACK RIVER ST, RM 4, SPARTA, WI 546561

01/29/2020 06/30/2020SCENIC BLUFFS HLTH CTR INC, 916 FERRY ST, LA CROSSE, WI 546011

Setting Begin/End DatesNon-Certified School Setting(s)08/05/2019 06/30/2020ARCADIA ELEMENTARY SCHOOL, 358 RIVER ST, ARCADIA, WI 54612

08/05/2019 06/30/2020ARCADIA HIGH SCHOOL, 756 RAIDER DR, ARCADIA, WI 54612

08/05/2019 06/30/2020ARCADIA MIDDLE SCHOOL, 725 FAIRFIELD ST, ARCADIA, WI 54612

07/01/2018 06/30/2020CASHTON ELEMENTARY SCHOOL, 436 FRONT STREET, CASHTON, WI 54619

07/01/2018 06/30/2020CASHTON MIDDLE/HIGH SCHOOL, 540 COE STREET, CASHTON, WI 54619

07/01/2018 06/30/2020HIGH POINT CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656

08/05/2019 06/30/2020KICKAPOO HIGH SCHOOL, S6250 STATE HWY 131, VIOLA, WI 54664

08/05/2019 06/30/2020LA FARGE HIGH SCHOOL, 301 W ADAMS ST, LA FARGE, WI 54639

07/01/2018 06/30/2020S.A.I.L..S. CHARTER SCHOOL, 201 E FRANKLIN STREET, SPARTA, WI 54656

07/01/2018 06/30/2020VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DR, VIROQUA, WI 54665

07/01/2018 06/30/2020WESTBY ELEMENTARY, 122 NELSON ST, WESTBY, WI 54667

SPARTA

3277MONROE COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/02/202001/02/2020

(608) 269-8935

(608) [email protected] HILLESHIEM

County: MonroeSPARTA, WI 54656112 SOUTH COURT ST RM 3000

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 01/02/2020 12/31/2020

Services

NO BRANCH LOCATIONS

1654MONROE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201910/01/1975

(608) 269-8935

(608) [email protected] HILLESHIEM

County: MonroeSPARTA, WI 54656112 S COURT ST RM 3000

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 01/01/2019 12/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

OCONTOOCONTO

2759BELLIN PSYCHIATRIC CENTER OCONTO HOSPITAL & MEDICAL CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/23/2007

(920) 431-0333

(920) [email protected] COUNARD

County: OcontoOCONTO, WI 54153820 ARBUTUS AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020BELLIN PSYCHIATRIC CENTER-MARINETTE, 2820 ROOSEVELT ROAD, MARINETTE, WI 541432

11/01/2018 10/31/2020GARFIELD ELEMENTARY, 1615 CARNEY BOULEVARD, MARINETTE, WI 541433

11/01/2018 10/31/2020MARINETTE HIGH SCHOOL, 2135 PIERCE AVENUE, MARINETTE, WI 541433

11/01/2018 10/31/2020MARINETTE MIDDLE SCHOOL, 1011 WATER STREET, MARINETTE, WI 541433

11/01/2018 10/31/2020MENEKAUNEE SURISE EARLY LEARNING CENTER, 115 HANCOCK STREET, MARINETTE, WI 541433

11/01/2018 10/31/2020MERRYMAN ELEMENTARY, 611 ELIZABETH AVENUE, MARINETTE, WI 541433

11/01/2018 10/31/2020OCONTO FALLS - WASHINGTON MIDDLE SCHOOL, 102 S WASHINGTON STREET, OCONTO FALLS, WI 54154

3

03/11/2019 10/31/2020OCONTO FALLS ELEMENTARY SCHOOL, 415 MARIE VOLK DR, OCONTO FALLS, WI 541543

11/01/2018 10/31/2020OCONTO FALLS HIGH SCHOOL, 210 N FARM ROAD, OCONTO FALLS, WI 541543

11/01/2018 10/31/2020OUR SAVIOUR'S LUTHERAN CHURCH, 1600 UNIVERSITY DRIVE, MARINETTE, WI 541433

11/01/2018 10/31/2020PARK ELEMENTARY, 1225 HOCKRIDGE STREET, MARINETTE, WI 541433

1719OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201804/01/1979

(920) 834-6889

(920) [email protected] HANKE

County: OcontoOCONTO, WI 54153501 PARK AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 09/01/2018 08/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

CSAS-PREVENTION DHS 75.04 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020NEW VIEW INDUSTRIES, 164 W PARK STREET, GILLETT, WI 541241

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Mental Health Program Directory By County, City, and Provider Name

ONEIDAMINOCQUA

2316LIMBERG & ASSOCIATES, COUNSELING FOR CHANGE

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/2000

(715) 358-9556

(715) [email protected] LIMBERG

County: OneidaMINOCQUA, WI 545488618 HIGHWAY 51 NORTH

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020LIMBERG & ASSOCIATES, COUNSELING FOR CHANGE, 1185 S 4TH AVE, PARK FALLS, WI 545521

RHINELANDER

2515ASCENSION ST MARY'S INPATIENT BEHAVIORAL HEALTH DEPARTMENT

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2004

(715) 361-2021

(715) [email protected] STEFONEK

County: OneidaRHINELANDER, WI 545012251 N SHORE DR #100

Service Begin/End DatesAdm Code

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1762ASCENSION ST MARY'S KOLLER BEHAVIORAL HEALTH

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/1985

(715) 361-2920

(715) [email protected] SCHIEK

County: OneidaRHINELANDER, WI 545011020 KABEL AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2018 05/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 06/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI 545201

06/01/2018 05/31/2020ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI 544871

06/01/2018 05/31/2020ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 930 E WALL STREET, EAGLE RIVER, WI 545212

06/01/2018 05/31/2020ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 240 MAPLE STREET, WOODRUFF, WI 545682

2977CORNERSTONE PSYCHOLOGICAL ASSOCIATES LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/14/2012

(715) 420-1202

(715) [email protected] F. MCGUIRE LPC

County: OneidaRHINELANDER, WI 54501315 S ONEIDA AVE SUITE 101

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3196HARMONY COUNSELING SERVICES LLC DBA TRANSITIONS CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/24/2018

(715) 365-6768

(715) [email protected] WEGE

County: OneidaRHINELANDER, WI 5450122 N PELHAM ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020NICOLET COLLEGE, 5364 COLLEGE DRIVE, RHINELANDER, WI 545011

01/01/2019 12/31/2020PHELPS, 4451 OLD SCHOOL RD, PHELPS, WI 545543

3188NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - RHINELANDER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/04/2017

(888) 226-8713

(715) [email protected] MAURER

County: OneidaRHINELANDER, WI 54501915 ACACIA LN

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

2742OPTIONS COUNSELING SERVICES LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202011/16/201904/17/2007

(715) 369-7301

(715) [email protected] DECORAH

County: OneidaRHINELANDER, WI 545011991 WINNEBAGO STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/16/2019 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/16/2019 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/16/2019 03/31/2020CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI 545013

11/16/2019 03/31/2020CRESCENT ELEMENTARY, 3319 BOYCE DRIVE, RHINELANDER, WI 545013

11/16/2019 03/31/2020HODAG CONNECTION LEARNING CENTER, 51B NORTH BROWN ST, RHINELANDER, WI 545013

11/16/2019 03/31/2020JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI 545013

11/16/2019 03/31/2020NORTHWOODS COMM. SECONDARY CHARTER SCHOOL, 665 COOLIDGE AVENUE, RHINELANDER, WI 54501

3

11/16/2019 03/31/2020NORTHWOODS COMMUNITY ELEMENTARY CHARTER SCHOOL, 9086 COUNTY HWY K, HARSHAW, WI 54529

3

11/16/2019 03/31/2020PELICAN ELEMENTARY, 3350 V HICKEY ROAD, RHINELANDER, WI 545013

11/16/2019 03/31/2020RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI 545013

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Mental Health Program Directory By County, City, and Provider Name

1427THE HUMAN SERVICE CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201809/01/1980

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 EAST TIMBER DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 10/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2018 09/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 10/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

3043THE HUMAN SERVICE CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/27/2014

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 EAST TIMBER DRIVE

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL UNIFIED BOARD DHS 36 07/01/2018 06/30/2020

CCS REGIONAL MODEL UNIFIED BOARD W/TELEHEALTH DHS 36 07/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

1426THE HUMAN SERVICE CENTER CSP

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201909/01/1980

(715) 369-2214

(715) [email protected] SHIMECK

County: OneidaRHINELANDER, WI 54501705 E. TIMBER DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 06/01/2019 05/31/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 06/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

OUTAGAMIEAPPLETON

2651ASCENSION MEDICAL GROUP BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201901/20/2005

(920) 730-4924

(920) [email protected] MCKENZIE

County: OutagamieAPPLETON, WI 549151531 S MADISON ST #580

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021ACSENSION MED GRP BEH HLTH INTERNAL MED, 1501 S MADISON ST, APPLETON, WI 549152

11/01/2019 10/31/2021ACSENSION MED GRP BEH HLTH KOELLER ST, 1855 S KOELLER, OSHKOSH, WI 549022

11/01/2019 10/31/2021ACSENSION MED GRP BEH HLTH RICHMOND ST, 3329 N RICHMOND ST, APPLETON, WI 549112

11/01/2019 10/31/2021ASCENSION MED GRP BEH HLTH NEENAH, 101 MAIN STREET, NEENAH, WI 549562

1860ASCENSION NE WISCONSIN - ST ELIZABETH CAMPUS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201902/01/1984

(920) 730-5480

(920) [email protected] REICH

County: OutagamieAPPLETON, WI 549151506 S ONEIDA STREET

Service Begin/End DatesAdm Code

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-ADOLESCENT INPATIENT DHS 61.79 11/01/2019 10/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 11/01/2019 10/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2984CATALPA HEALTH INC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2012

(920) 882-5495

(920) [email protected] RADTKE

County: OutagamieAPPLETON, WI 54914444 NORTH WESTHILL BLVD

Service Begin/End DatesAdm Code

CSAS-PREVENTION DHS 75.04 11/01/2019 10/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 11/01/2019 10/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021BOYS AND GIRLS CLUB OF OSHKOSH, 501 E PARKWAY AVENUE, OSHKOSH, WI 549011

11/01/2019 10/31/2021CATALPA HEALTH - CASALOMA CAMPUS, 1920 N CASALOMA ST, APPLETON, WI 549132

11/01/2019 10/31/2021CATALPA HEALTH - WAUPACA, 815 WEST FULTON ST, WAUPACA, WI 549812

11/01/2019 10/31/2021CATALPA HEALTH ACCESS CENTER, 442 WESTHILL BLVD., APPLETON, WI 549142

11/01/2019 10/31/2021CATALPA HEALTH, 540 N KOELLER ST, OSHKOSH, WI 549022

11/01/2019 10/31/2021THEDACARE PHYSICIANS PEDIATRICS, 640 DEERWOOD AVENUE, NEENAH, WI 549562

11/01/2019 10/31/2021BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 308 EAST BURDICK ST, BLACK CREEK, WI 541063

11/01/2019 10/31/2021BUTTE DES MORTS ELEMENTARY, 501 TAYCO ST, MENASHA, WI 549523

11/01/2019 10/31/2021CARL TRAGER MIDDLE SCHOOL, 3000 W 20TH AVE, OSHKOSH, WI 549043

11/01/2019 10/31/2021CHILTON HIGH SCHOOL, 530 W MAIN ST, CHILTON, WI 530143

11/01/2019 10/31/2021CHILTON MIDDLE SCHOOL, 421 COURT ST, CHILTON, WI 530143

11/01/2019 10/31/2021CLAY LAMBERTON ELEMENTARY, 259 E MARQUETTE ST, BERLIN, WI 549233

11/01/2019 10/31/2021CLAYTON ELEMENTARY SCHOOL, 2916 WEST FAIRVIEW ROAD, NEENAH, WI 549563

11/01/2019 10/31/2021CLOVIS GROVE ELEMENTARY SCHOOL, 974 9TH ST, MENASHA, WI 549523

11/01/2019 10/31/2021COOLIDGE ELEMENTARY SCHOOL, 321 ALCOTT DRIVE, NEENAH, WI 549563

11/01/2019 10/31/2021FREEDOM ELEMENTARY SCHOOL, N3569 COUNTY ROAD E, FREEDOM, WI 549133

11/01/2019 10/31/2021FREEDOM HIGH & MIDDLE SCHOOLS, N4021 COUNTY ROAD E, FREEDOM, WI 549133

11/01/2019 10/31/2021GEGAN ELEMENTARY, 675 AIRPORT RD, MENASHA, WI 549523

11/01/2019 10/31/2021GREENVILLE ELEMENTARY SCHOOL, W6822 GREENRIDGE DR., GREENVILLE, WI 549423

11/01/2019 10/31/2021GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR., GREENVILLE, WI 549423

12/16/2019 10/31/2021HILBERT K-12, 1139 W MILWAUKEE ST, HILBERT, WI 541293

11/01/2019 10/31/2021HOOVER ELEMENTARY SCHOOL, 950 HUNT AVENUE, NEENAH, WI 549563

11/01/2019 10/31/2021HORACE MANN INTERMEDIATE SCHOOL, 1021 OAK ST, NEENAH, WI 549563

11/01/2019 10/31/2021HORIZON ELEMENTARY SCHOOL, 2101 SCHAEFER CIRCLE, APPLETON, WI 549153

11/01/2019 10/31/2021HORTONVILLE ELEMENTARY SCHOOL, 240 WARNER ST., HORTONVILLE, WI 549443

11/01/2019 10/31/2021HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 220, HORTONVILLE, WI 549443

11/01/2019 10/31/2021HORTONVILLE MIDDLE SCHOOL, 220 WARNER ST; PO BOX 359, HORTONVILLE, WI 549443

11/01/2019 10/31/2021JAMES MADISON MIDDLE SCHOOL, 2020 S. CARPENTER STREET, APPLETON, WI 549153

01/06/2020 10/31/2021JEFFERSON ELEMENTARY SCHOOL, 244 W 11TH AVE, OSHKOSH, WI 549023

11/01/2019 10/31/2021KALEIDOSCOPE ACADEMY, 318 EAST BREWSTER ST, APPLETON, WI 549113

11/01/2019 10/31/2021LAKEVIEW ELEMENTARY SCHOOL, 1645 S. COMMERCIAL ST., NEENAH, WI 549563

11/01/2019 10/31/2021MERRILL MIDDLE SCHOOL, 108 W NEW YORK AVE, OSHKOSH, WI 549013

11/01/2019 10/31/2021NEENAH HIGH SCHOOL, 1275 TULLAR ROAD, NEENAH, WI 549563

11/01/2019 10/31/2021NICOLET ELEMENTARY SCHOOL, 449 AHNAIP ST, MENASHA, WI 549523

11/01/2019 10/31/2021NORTH GREENVILLE ELEMENTARY SCHOOL, N2468 LEARNING WAY, GREENVILLE, WI 549423

11/01/2019 10/31/2021OSHKOSH NORTH HIGH SCHOOL, 1100 W. SMITH AVE., OSHKOSH, WI 549013

11/01/2019 10/31/2021OSHKOSH WEST HIGH SCHOOL, 375 N EAGLE ST, OSHKOSH, WI 549023

01/07/2020 10/31/2021PERRY TIPLER MIDDLE SCHOOL, 325 S EAGLE ST, OSHKOSH, WI 549023

11/01/2019 10/31/2021READ ELEMENTARY SCHOOL, 1120 ALGOMA BLVD, OSHKOSH, WI 549013

11/01/2019 10/31/2021ROCKLEDGE INTERMEDIATE CENTER, 330 W HICKORY ST, SEYMOUR, WI 541653

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11/01/2019 10/31/2021ROCKLEDGE PRIMARY CENTER, 330 WEST HICKORY ST, SEYMOUR, WI 541653

11/01/2019 10/31/2021ROOSEVELT ELEMENTARY SCHOOL, 1645 S COMMERCIAL STREET, NEENAH, WI 549563

11/01/2019 10/31/2021SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI 541703

01/07/2020 10/31/2021SOUTH PARK MIDDLE SCHOOL, 1551 DELAWARE ST, OSHKOSH, WI 549023

11/01/2019 10/31/2021SPRING ROAD ELEMENTARY SCHOOL, 1191 COUNTY ROAD II, NEENAH, WI 549563

11/01/2019 10/31/2021TAFT ELEMENTARY SCHOOL, 133 WESTERN AVENUE, NEENAH, WI 549563

11/01/2019 10/31/2021TULLAR ELEMENTARY SCHOOL, 925 TULLAR ROAD, NEENAH, WI 549563

11/01/2019 10/31/2021WASHINGTON ELEMENTARY SCHOOL, 929 WINNEBAGO AVE, OSHKOSH, WI 549013

11/01/2019 10/31/2021WAUPACA HIGH SCHOOL, E2325 KING ROAD, WAUPACA, WI 549813

11/01/2019 10/31/2021WAUPACA LEARNING CENTER ELEMENTARY SCHOOL, 1515 SHOEMAKER ROAD, WAUPACA, WI 54981

3

11/01/2019 10/31/2021WAUPACA MIDDLE SCHOOL, 1149 SHOEMAKER ROAD, WAUPACA, WI 549813

11/01/2019 10/31/2021WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI 549013

11/01/2019 10/31/2021WILSON ELEMENTARY SCHOOL, 920 HIGGINS AVENUE, NEENAH, WI 549563

2872LUTHERAN SOCIAL SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201906/02/2009

(920) 734-2824

(920) [email protected] KRAFT

County: OutagamieAPPLETON, WI 549113003 B NORTH RICHMOND ST

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021LUTHERAN SOCIAL SERVICES, 1850 CRANSTON ROAD, BELOIT, WI 535111

09/01/2019 08/31/2021LUTHERAN SOCIAL SERVICES, 612 N RANDALL AVE, JANESVILLE, WI 535452

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2019 08/31/2021LSS-APPLETON EAST HIGH SCHOOL, 2121 E EMMERS DR, APPLETON, WI 54915

09/01/2019 08/31/2021LSS-APPLETON NORTH HIGH SCHOOL, 5000 N BALLARD RD, APPLETON, WI 54913

09/01/2019 08/31/2021LSS-APPLETON WEST HIGH SCHOOL, 610 N BADGER AVE, APPLETON, WI 54914

09/01/2019 08/31/2021LSS-BRUCE-GUADALUPE COMM SCHOOL, 1028 S 9TH ST, MILWAUKEE, WI 53204

09/01/2019 08/31/2021LSS-BRUCE-GUALALUPE MIDDLE SCHOOL, 920 S 9TH ST, MILWAUKEE, WI 53204

09/01/2019 08/31/2021LSS-EINSTEIN MIDDLE SCHOOL, 324 E FLORIDA AVE, APPLETON, WI 54911

09/01/2019 08/31/2021LSS-LINCOLN ELEMENTARY SCHOOL, 1000 N MASON ST, APPLETON, WI 54911

09/01/2019 08/31/2021LSS-MAPLEWOOD MIDDLE SCHOOL, 1600 MIDWAY RD, MENASHA, WI 54952

09/01/2019 08/31/2021LSS-MENASHA HIGH SCHOOL, 328 SEVENTH ST, MENASHA, WI 54952

09/01/2019 08/31/2021LSS-WILSON MIDDLE SCHOOL, 225 N BADGER AVE, APPLETON, WI 54914

09/01/2019 08/31/2021UCC ACOSTA MIDDLE SCHOOL, 1038 S 6TH ST, MILWAUKEE, WI 53204

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2512OPTIONS TREATMENT PROGRAMS INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2004

(920) 735-9050

(920) [email protected] HAGEN

County: OutagamieAPPLETON, WI 549141000 N LYNNDALE DRIVE STE C

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2018 03/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS, INC., 424 S MONROE AVE #201, GREEN BAY, WI 543012

04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS, INC., 922 CHURCHILL ST, WAUPACA, WI 549812

04/01/2018 03/31/2020OPTIONS TREATMENT PROGRAMS-OSHKOSH, 502 E. NEW YORK AVE., OSHKOSH, WI 549012

2314OUTAGAMIE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1987

(920) 832-5488

(920) [email protected] BEZIER

County: OutagamieAPPLETON, WI 54911320 S WALNUT ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1724OUTAGAMIE COUNTY DEPT OF HEALTH & HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201907/01/1987

(920) 832-4767

(920) [email protected] RENTERIA

County: OutagamieAPPLETON, WI 54911320 S WALNUT ST

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2590OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2005

(920) 832-5488

(920) [email protected] VAN RYZIN

County: OutagamieAPPLETON, WI 54911320 S WALNUT ST

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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2794PARTNERSHIP COMMUNITY HEALTH CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2008

(920) 882-2946

(920) [email protected] STACKER

County: OutagamieAPPLETON, WI 549135471 WATERFORD LANE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021COTS, INC, 913 S. WEST AVE, APPLETON, WI 549151

3098ROGERS MEMORIAL HOSPITAL - APPLETON

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201809/21/2015

(262) 464-1049

(262) [email protected] SCHULTZ

County: OutagamieAPPLETON, WI 549144351 W COLLEGE AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2018 08/31/2020

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 09/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 12/05/2018 08/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B)

12/05/2018 11/29/2019

Services

NO BRANCH LOCATIONS

3115SARIS COUNSELING LLC DBA EVOLVE

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2016

(920) 243-1792

(920) [email protected] VELISSARIS

County: OutagamieAPPLETON, WI 549143416 ASSOCIATION DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

2450SHERMAN COUNSELING MANAGEMENT

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/05/2003

(920) 733-6565

(920) 733-2065 [email protected] DREWEK

County: OutagamieAPPLETON, WI 54914W6144 AREOTECH DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2018 05/31/2020SHERMAN CONSULTING - APPLETON NORTH, 2505 E EVERGREEN DR STE C, APPLETON, WI 549132

07/10/2019 05/31/2020SHERMAN COUNSELING - FOND DU LAC, 131 N ROLLING MEADOWS, STE C, FOND DU LAC, WI 54937

2

06/01/2018 05/31/2020SHERMAN COUNSELING - GREEN BAY, 2270 HOLMGREN WAY, GREEN BAY, WI 543042

07/10/2019 05/31/2020SHERMAN COUNSELING - MANITOWOC, 980 MARITIME DR, STE 6, MANITOWOC, WI 542202

06/01/2018 05/31/2020SHERMAN COUNSELING - OSHKOSH, 2370 STATE ROAD 44, #D, OSHKOSH, WI 549042

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1997WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201805/01/1990

(262) 345-5531

(262) [email protected] ROBINSON

County: OutagamieAPPLETON, WI 549144351 WEST COLLEGE AVE #410

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020WLCFS - CHRISTIAN FAMILY SOLUTIONS, 757 S MAIN ST, STE 8, FOND DU LAC, WI 549352

09/01/2018 08/31/2020FOX VALLEY LUTHERAN HS, 5300 N MEADE ST, APPLETON, WI 549133

09/01/2018 08/31/2020NORTHLAND LUTHERAN HS, 2107 TOWER ROAD, MOSINEE, WI 544553

09/01/2018 08/31/2020WINNEBAGO LUTHERAN ACADEMY, 475 E MERRILL AVE, FOND DU LAC, WI 549353

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OZAUKEECEDARBURG

1695NORTHSHORE CLINIC & CONSULTANTS, INC.

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201910/01/1987

(262) 375-1071

(262) [email protected] RUPPNOW

County: OzaukeeCEDARBURG, WI 53012W62 N248 WASHINGTON AVE., #207

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2021NORTHSHORE CLINIC & CONSULTANTS, 207 E BUFFALO STREET, #510, MILWAUKEE, WI 532022

08/01/2019 07/31/2021NORTHSHORE CLINIC & CONSULTANTS, 2363 S 102ND STREET, #203, WEST ALLIS, WI 532272

08/01/2019 07/31/2021NORTHSHORE CLINIC & CONSULTANTS, INC., 1615 BARTON AVENUE, WEST BEND, WI 530902

MEQUON

2368AMERICAN BEHAVIORAL CLINICS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202007/01/201805/01/2002

(262) 241-4311

(262) [email protected] SCHRINSKY

County: OzaukeeMEQUON, WI 530921240 W RANCHITO LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #2, 9720 W BLUEMOUND ROAD, MILWAUKEE, WI

532261

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #1, 10424 W BLUEMOUND ROAD, MILWAUKEE, WI 53226

2

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-ELM GROVE, 15285 WATERTOWN PLANK ROAD, ELM GROVE, WI 53122

2

07/01/2018 05/31/2020AMERICAN BEHAVIORAL CLINICS-LAYTON, 7330 W LAYTON AVENUE, MILWAUKEE, WI 532202

2507COLUMBIA ST MARY'S BEHAVIORAL MEDICINE-MEQUON

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/02/2003

(262) 241-6132

(262) [email protected] GAURKEE

County: OzaukeeMEQUON, WI 5309713111 N PORT WASHINGTON ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 03/01/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

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1873COLUMBIA ST. MARY'S OZAUKEE HOSPITAL BEHAVIORAL HEALTH UNIT

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201809/01/1984

(262) 243-8380

(262) [email protected] GAURKEE

County: OzaukeeMEQUON, WI 5309713111 N PORT WASHINGTON RD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 03/01/2018 02/29/2020

MENTAL HEALTH-INPATIENT DHS 61.71 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

2747GREENSQUARE DEVELOPMENTAL SPECIALISTS

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/17/2007

(414) 247-0894

(414) [email protected] CLEMENS

County: OzaukeeMEQUON, WI 530921655 WEST MEQUON ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020GREENSQUARE COA GOLDIN CENTER, 2320 WEST BURLEIGH ST, MILWAUKEE, WI 532061

08/01/2018 07/31/2020GREENSQUARE YMCA, 1350 W NORTH AVE, MILWAUKEE, WI 532051

08/01/2018 07/31/2020GREENSQUARE BAYSHORE, 7950 N PORT WASHINGTON RD, FOX POINT, WI 532172

08/01/2018 07/31/2020GREENSQUARE FOREST VIEW, 4855 S MOORELAND RD SUITE 150, NEW BERLIN, WI 531512

08/01/2018 07/31/2020GREENSQUARE FRANKLIN, 7322 W RAWSON AVE, FRANKLIN, WI 531322

08/01/2018 07/31/2020GREENSQUARE GREENFIELD, 3365 S 103RD ST #210, MILWAUKEE, WI 532272

08/01/2018 07/31/2020GREENSQUARE MIDTOWN, 5433 WEST FOND DU LAC AVE, MILWAUKEE, WI 532162

08/01/2018 07/31/2020GREENSQUARE NEXT DOOR, 2561 NORTH 29TH ST, MILWAUKEE, WI 532162

07/03/2019 07/31/2020GREENSQUARE PEWAUKEE, 1215 GEORGE TOWNE DR, PEWAUKEE, WI 530722

08/01/2018 07/31/2020GREENSQUARE RIVER GLEN, 4655 N PORT WASHINGTON RD #200, GLENDALE, WI 532122

PORT WASHINGTON

1276DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201806/01/1977

(262) 238-8104

(262) [email protected] CARLSON

County: OzaukeePORT WASHINGTON, WI 53074121 W. MAIN STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2274DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY CSP

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201906/01/1977

(262) 238-8104

(262) [email protected] CARLSON

County: OzaukeePORT WASHINGTON, WI 53074121 W. MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

3050OZAUKEE COUNTY CCS PROGRAM

Surveyor: Connie Knezic

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201809/22/2014

(262) 284-8104

(262) [email protected] CARLSON

County: OzaukeePORT WASHINGTON, WI 53074121 W MAIN STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

PEPINDURAND

2887CATALYST FOR CHANGE CONSULTANTS, LLP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/24/2009

(608) 268-9824

(715) [email protected] JULEFF

County: PepinDURAND, WI 547361316 E PROSPECT ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

PIERCEELLSWORTH

1737PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201912/01/1981

(715) 273-6862

(715) [email protected] KIESLER

County: PierceELLSWORTH, WI 54011412 W KINNE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

2963PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES/NORTHWEST CONNECTIONS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201911/01/2011

(715) 273-6862

(715) [email protected] KIESLER

County: PierceELLSWORTH, WI 54011412 W. KINNE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2019 03/31/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 04/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

3020PIERCE COUNTY DEPT OF HUMAN SVS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/01/2014

(715) 273-6862

(715) [email protected] KIESLER

County: PierceELLSWORTH, WI 54011412 WEST KINNE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

POLKAMERY

2839AMERY REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/08/2008

(715) 268-0061

(715) 268-0060Heather.E.Erickson@AmerymedicalHEATHER ERICKSON

County: PolkAMERY, WI 54001230 DERONDA STREET

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021CLEAR LAKE CLINIC, 357 THIRD AVENUE, CLEAR LAKE, WI 540051

12/01/2019 11/30/2021LUCK CLINIC, AMERY HOSPITAL AND CLINIC, 2547 STATE ROAD 35, SUITE 1, LUCK, WI 548531

12/01/2019 11/30/2021TURTLE LAKE CLINIC, 550 MARTIN AVENUE, TURTLE LAKE, WI 548891

2195NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - AMERY

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201802/14/2000

(888) 625-8641

(715) [email protected] MAURER

County: PolkAMERY, WI 540011096 APPLE AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2018 01/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

02/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

BALSAM LAKE

2222POLK COUNTY BEHAVIORAL HEALTH DEPARTMENT CSP

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201801/26/2000

(715) 485-8450

(715) [email protected] LAVASSEUR

County: PolkBALSAM LAKE, WI 54810100 POLK CO PLAZA #50

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

2204POLK COUNTY BEHAVIORAL HEALTH DEPT

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/08/2000

(715) 485-8490

(715) [email protected] LAVASSEUR

County: PolkBALSAM LAKE, WI 54810100 POLK COUNTY PLAZA #50

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 09/12/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

FREDERIC

2254NORTHWEST COUNSELING AND GUIDANCE CLINIC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201808/25/1999

(715) 327-4470

(715) [email protected] FREDRICKSON

County: PolkFREDERIC, WI 54837203 UNITED WAY DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2018 01/31/2020NORTHWEST PASSAGE RIVERSIDE, 7818 MOLINE RD, PO BOX 349, WEBSTER, WI 548932

OSCEOLA

2792PEACE TREE COUNSELING LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/24/2008

(715) 417-3243

(715) [email protected] ZELLMER

County: PolkOSCEOLA, WI 54020108 CHIEFTAIN ST STE B

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier06/01/2019 05/31/2021PEACE TREE COUNSELING, LLC, 710 N MAIN STREET #101B, RIVER FALLS, WI 540222

Setting Begin/End DatesNon-Certified School Setting(s)06/01/2019 05/31/2021FREDERIC ELEMENTARY SCHOOL, 305 BIRCH ST, FREDERIC, WI 54837

06/01/2019 05/31/2021FREDERIC HIGH SCHOOL, 1437 CLAM FALLS DR, FREDERIC, WI 54837

06/01/2019 05/31/2021OSCEOLA ELEMENTARY SCHOOL, 250 10TH AVE EAST, OSCEOLA, WI 54020

06/01/2019 05/31/2021OSCEOLA HIGH SCHOOL, 1111 OAK RIDGE DR, OSCEOLA, WI 54020

06/01/2019 05/31/2021OSCEOLA INTERMEDIATE SCHOOL, 949 EDUCATION AVE, OSCEOLA, WI 54020

06/01/2019 05/31/2021OSCEOLA MIDDLE SCHOOL, 1029 OAK RIDGE DR, OSCEOLA, WI 54020

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Mental Health Program Directory By County, City, and Provider Name

PORTAGEPLOVER

2566OSWALD COUNSELING ASSOCIATES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/14/2005

(715) 342-0291

(715) [email protected] OSWALD

County: PortagePLOVER, WI 544672450 VINEYARD DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

STEVENS POINT

3051ADVOCATE PSYCHOTHERAPY SERVICES, LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/01/2014

(715) 952-4995

(800) [email protected] JOHNSON

County: PortageSTEVENS POINT, WI 544823233A BUSINESS PARK DR, STE 304

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 09/30/2020BOYS & GIRLS CLUB OF PORTAGE CO, 2401 CEDAR DR, PLOVER, WI 544671

07/01/2019 09/30/2020BOYS & GIRLS CLUB OF PORTAGE CO, 941 MICHIGAN AVE, STEVENS POINT, WI 544811

Setting Begin/End DatesNon-Certified School Setting(s)02/12/2019 09/30/2020HOWE ELEMENTARY SCHOOL, 221 8TH ST N, WISCONSIN RAPIDS, WI 54494

10/01/2018 09/30/2020KENNEDY ELEMENTARY SCHOOL, 616 WEST SECOND STREET, JUNCTION CITY, WI 54443

10/01/2018 09/30/2020MEAD ELEMENTARY CHARTER SCHOOL, 241 - 17TH STREET SOUTH, WISCONSIN RAPIDS, WI 54495

10/01/2018 09/30/2020TRI-COUNTY AREA SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 54966

10/31/2019 09/30/2020WISCONSIN RAPIDS MIDDLE SCHOOL, 1921 27TH AVE S, WISCONSIN RAPIDS, WI 54495

01/07/2019 09/30/2020WOODSIDE ELEMENTARY SCHOOL, 611 - 2 MILE AVENUE, WISCONSIN RAPIDS, WI 54494

1796ASCENSION MEDICAL GROUP - NORTHERN WISCONSIN, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202012/01/1983

(715) 343-2088

(715) [email protected] TRZEBIATOWSKI

County: PortageSTEVENS POINT, WI 544813398 E MARIA DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021ASCENSION MED GRP PSYCHIATRY DEPT, 122 WILSHIRE BLVD NORTH BLDG 2, STEVENS POINT,

WI 544812

01/01/2020 12/31/2021WESTON CLINIC, 3301 CRANBERRY BLVD, WESTON, WI 544762

01/01/2020 12/31/2021BANNACH ELEMENTARY SCHOOL, 5400 WALTER STREET, STEVENS POINT, WI 544813

01/08/2020 12/31/2021PJ JACOBS JUNIOR HIGH SCHOOL, 2400 MAIN ST, STEVENS POINT, WI 544813

01/01/2020 12/31/2021STEVENS POINT AREA SENIOR HIGH, 1201 NORTHPOINT DR, STEVENS POINT, WI 544813

01/01/2020 12/31/2021WASHINGTON ELEMENTARY, 3500 PRAIS STREET, STEVENS POINT, WI 544813

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Mental Health Program Directory By County, City, and Provider Name

1217ASCENSION ST MICHAELS BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201905/01/1991

(715) 344-8127

(715) [email protected] ROBERTS

County: PortageSTEVENS POINT, WI 54481209 PRENTICE ST N

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021ASCENSION ST MICHAELS BEHAVIORAL HEALTH, 190 GRAND SEASONS DR, WAUPACA, WI 549812

1820ASCENSION ST MICHAELS BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201905/01/1978

(715) 346-5571

(715) [email protected] ROBERTS

County: PortageSTEVENS POINT, WI 54481900 ILLINOIS AVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 10/01/2019 09/30/2021

MENTAL HEALTH-INPATIENT DHS 61.71 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

1662NEW DIRECTIONS COUNSELING CENTER, LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201809/16/1996

(715) 345-2938

(715) [email protected] DICKINSON

County: PortageSTEVENS POINT, WI 544825541 HWY 10 EAST, SUITE B

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/11/2019 05/31/2020BOYS & GIRLS CLUB OF PORTAGE CO, 941 MICHIGAN AVE, STEVENS POINT, WI 544811

06/01/2018 05/31/2020NEW DIRECTIONS COUNSELING CENTER, N2919 COUNTY RD QQ, WAUPACA, WI 549811

06/01/2018 05/31/2020BEN FRANKLIN JR JIGH, 2000 POLK ST, STEVENS POINT, WI 544813

06/01/2018 05/31/2020PJ JACOBS JUNIOR HIGH SCHOOL, 2400 MAIN ST, STEVENS POINT, WI 544813

06/01/2018 05/31/2020PLOVER-WHITING ELEMENTARY SCHOOL, 1400 HOOVER AVENUE, PLOVER, WI 544673

06/01/2018 05/31/2020ROOSEVELT IDEA ELEMENTARY SCHOOL, 2200 WISCONSIN AVE., PLOVER, WI 544673

06/01/2018 05/31/2020STEVENS POINT AREA SENIOR HIGH SCHOOL, 1201 NORTH POINT DR., STEVENS POINT, WI 544813

06/01/2018 05/31/2020WAUPACA HIGH SCHOOL, E2325 KING ROAD, WAUPACA, WI 549813

06/01/2018 05/31/2020WAUPACA LEARNING CENTER, 1515 SHOEMAKER ROAD, WAUPACA, WI 549813

06/01/2018 05/31/2020WAUPACA MIDDLE SCHOOL, 515 SHOEMAKER ROAD, WAUPACA, WI 549813

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Mental Health Program Directory By County, City, and Provider Name

2405NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - STEVENS POINT

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201910/14/2002

(844) 810-8859

(715) [email protected] MAURER

County: PortageSTEVENS POINT, WI 54481931 MICHIGAN AVE STE 101

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 02/01/2019 01/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

02/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

1740PORTAGE COUNTY HEALTH & HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201906/01/1976

(715) 345-5966

(715) [email protected] HAKE

County: PortageSTEVENS POINT, WI 54481817 WHITING AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

2712PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2007

(715) 345-5966

(715) [email protected] HAKE

County: PortageSTEVENS POINT, WI 54481817 WHITING AVENUE

CCS Affiliaton: 09/01/2014Begin: End: Lead:Portage Wood Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

2230RIVERWOOD COUNSELING ASSOCIATES LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/17/2000

(715) 343-5899

(715) [email protected] A MILLER

County: PortageSTEVENS POINT, WI 544811052 MAIN STREET, #202

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

PRICEPHILLIPS

3256ACCESS, INC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201905/01/2019

(715) 235-2688

(715) [email protected] WOLF

County: PricePHILLIPS, WI 54555171 CHESTNUT ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 05/21/2019

11/29/2019

Services

NO BRANCH LOCATIONS

2644PRICE COUNTY HEALTH & HUMAN SERVICES/AURORA

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201902/01/2006

(715) 339-4018

(715) [email protected] SCHREUDER

County: PricePHILLIPS, WI 54555104 S EYDER

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2019 01/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

RACINEBURLINGTON

1089AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202111/25/201910/01/1983

(262) 763-9326

(262) [email protected] VALENTIN

County: RacineBURLINGTON, WI 53105116 DODGE STREET, STE 3

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/25/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/25/2019 01/31/2021AURORA MED GROUP BEHAV HLTH-WATERFORD, 818 FORREST, WATERFORD, WI 531852

1206CLINICAL PSYCHOLOGY ASSOCIATES OF BURLINGTON

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/01/1993

(262) 763-7767

(262) [email protected] W THOMPSON PHD

County: RacineBURLINGTON, WI 53105345 MILWAUKEE AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2018 03/31/2020CLINICAL PSYCHOLOGY ASSOC OF WATERFORD, 207B MILWAUKEE AVENUE, WATERFORD, WI

531851

Setting Begin/End DatesNon-Certified School Setting(s)01/29/2019 03/31/2020BURLINGTON HIGH SCHOOL, 4000 MCCANNA PKWY, BURLINGTON, WI 53105

01/29/2019 03/31/2020DYER INTERMEDIATE SCHOOL, 201 S KENDRICK AVE, BURLINGTON, WI 53105

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Mental Health Program Directory By County, City, and Provider Name

RACINE

1027ASCENSION ALL SAINTS MENTAL HEALTH & ADDICTION CARE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202008/09/201807/01/1990

(262) 687-2802

(262) [email protected] YONKOSKI

County: RacineRACINE, WI 534031320 WISCONSIN AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 08/09/2018 06/30/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 08/09/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/09/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/09/2018 06/30/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 08/09/2018 06/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/09/2018 06/30/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 08/09/2018 06/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 08/09/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/06/2018 06/30/2020ASCENSION ALL SAINTS - CARDIAC REHAB, 3803 SPRING ST, RACINE, WI 534051

01/22/2020 06/30/2020AHCMP, 10180 WASHINGTON AVE, MOUNT PLEASANT, WI 531772

08/09/2018 06/30/2020ASCENSION ALL SAINTS - FAMILY MED CLINIC, 3807 SPRING ST #3063A, RACINE, WI 534052

06/25/2019 06/30/2020ASCENSION ALL SAINTS - FAMILY MEDICINE, 1320 WISCONSIN AVE, RACINE, WI 534032

08/09/2018 06/30/2020ASCENSION ALL SAINTS - FOUR MILE, 2408 FOUR MILE ROAD, RACINE, WI 534022

08/09/2018 06/30/2020ASCENSION ALL SAINTS - MT PLEASANT, 4328 OLD GREEN BAY RD, MOUNT PLEASANT, WI 534032

08/09/2018 06/30/2020ASCENSION ALL SAINTS - NEUROLOGY, 3805B SPRING ST 3RD FLOOR, RACINE, WI 534052

08/09/2018 06/30/2020ASCENSION ALL SAINTS - OAK CREEK, 8020 S HOWELL AVE, OAK CREEK, WI 531542

06/25/2019 06/30/2020ASCENSION ALL SAINTS - ONCOLOGY, 3809 SPRING ST, RACINE, WI 534052

08/09/2018 06/30/2020ASCENSION ALL SAINTS - SLHP, 3821 SPRING ST, RACINE, WI 534052

08/09/2018 06/30/2020ASCENSION ALL SAINTS - SUITE 20, 3805B SPRING ST LL-20, RACINE, WI 534052

08/09/2018 06/30/2020ASCENSION ALL SAINTS - SUITE 240, 3805B SPRING ST #240, RACINE, WI 534052

09/06/2018 06/30/2020ASCENSION ALL SAINTS - SUITE 340, 3805B SPRING ST #340, RACINE, WI 534052

08/09/2018 06/30/2020ASCENSION ALL SAINTS - UNION GROVE, 1120 MAIN ST, UNION GROVE, WI 531822

2976BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201908/02/2012

(262) 638-6540

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2019 07/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/01/2019 11/29/2019

CSAS-PREVENTION DHS 75.04 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2019 07/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1135CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/01/1981

(262) 637-0695

(414) [email protected] BIBO

County: RacineRACINE, WI 53403800 WISCONSIN AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020CATHOLIC CHARITIES OF MILW - KENOSHA, 2224 45TH ST., KENOSHA, WI 531401

1180CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/1984

(262) 633-2619

(262) [email protected] HULETZ

County: RacineRACINE, WI 534068800 WASHINGTON AVE, SUITE 100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021CSSW - BURLINGTON, 480 S PINE, BURLINGTON, WI 531052

Setting Begin/End DatesNon-Certified School Setting(s)10/01/2019 09/30/2021FRATT ELEMENTARY SCHOOL, 3501 KINZIE AVE, RACINE, WI 53405

10/01/2019 09/30/2021GIFFORD K-8, 8332 NORTHWESTERN AVE, RACINE, WI 53406

10/01/2019 09/30/2021JERSTAD-AGERHOLM K-8, 3535 LASALLE ST, RACINE, WI 53402

10/01/2019 09/30/2021JULIAN THOMAS ELEMENTARY SCHOOL, 930 DR MARTIN LUTHER KING DR, RACINE, WI 53404

10/01/2019 09/30/2021KNAPP ELEMENTARY SCHOOL, 2701 17TH ST, RACINE, WI 53405

10/01/2019 09/30/2021MITCHELL K-8, 2701 DREXEL AVE, RACINE, WI 53405

10/01/2019 09/30/2021SC JOHNSON ELEMENTARY SCHOOL, 2420 KENTUCKY ST, RACINE, WI 53404

10/01/2019 09/30/2021WADEWITZ ELEMENTARY SCHOOL, 2700 YOUT ST, RACINE, WI 53404

2958DEROSE FAMILY COUNSELING LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/07/2012

(262) 633-1236

(262) [email protected] DEROSE

County: RacineRACINE, WI 53403316 5TH STREET SUITE 1

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

1339FAMILY SERVICE OF RACINE, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201911/01/1983

(262) 634-5342

(262) [email protected] HANSON WILL

County: RacineRACINE, WI 53403420 SEVENTH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3212LAKESIDE FAMILY THERAPY SERVICES, LTD

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202108/01/201907/02/2018

(262) 637-9995

(262) [email protected] V MCRAE

County: RacineRACINE, WI 534064810 NORTHWESTERN AVE

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

2773PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201902/05/2008

(262) 884-9735

(262) [email protected] PORTIS-PATTERSON

County: RacineRACINE, WI 534065801 WASHINGTON AVENUE, #110

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

3031RACINE COUNTY CCS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201905/08/2014

(262) 638-6983

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVE

CCS Affiliaton: 12/01/2014Begin: End: Lead:Kenosha Racine Regional Consortium (KRRC)

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/01/2019 05/31/2021

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 06/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2490RACINE COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/14/2004

(262) 638-6983

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

2952RACINE COUNTY HUMAN SERVICES DEPARTMENT COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2011

(262) 638-6983

(262) [email protected] GOGGINS

County: RacineRACINE, WI 534031717 TAYLOR AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

STURTEVANT

1757PSYCHIATRIC SERVICES OF RACINE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201805/01/1988

(262) 635-5530

(262) [email protected] ROGINSKI

County: RacineSTURTEVANT, WI 531778700 DURAND AVE #600

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

WATERFORD

2934LAKEVIEW CARE PARTNERS WISCONSIN

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/14/2011

(262) 534-8553

(262) [email protected]. CYNTHIA SORENSON

County: RacineWATERFORD, WI 531851701 SHARP ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

RAMSEYMAPLEWOOD

2903FAMILY INNOVATIONS INC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202005/01/201805/01/2013

(651) 773-7591

(651) [email protected] RUNION

County: RamseyMAPLEWOOD, MN 551092103 B&C COUNTY RD D EAST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 05/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 05/31/2020FAMILY INNOVATIONS, INC, 131 CARMICHAEL, HUDSON, WI 540162

05/01/2018 05/31/2020FAMILY INNOVATIONS, INC, 215 MAIN STREET STE 205, BALSAM LAKE, WI 548102

05/01/2018 05/31/2020FAMILY INNOVATIONS, INC., 6303 OSGOOD AVE, STILLWATER, MN 550822

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Mental Health Program Directory By County, City, and Provider Name

RICHLANDRICHLAND CENTER

3267PINE COUNSELING INC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202011/13/201911/13/2019

(608) 383-1480

(931) [email protected] M KRAMER

County: RichlandRICHLAND CENTER, WI 53581204 S ORANGE ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/03/2020 11/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/13/2019 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/13/2019 11/30/2020

Services

NO BRANCH LOCATIONS

1797RICHLAND COUNTY HEALTH & HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/1988

(608) 647-6611

(608) [email protected] CULVER

County: RichlandRICHLAND CENTER, WI 53581221 W SEMINARY STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 02/01/2018 01/31/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 02/01/2018 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 02/01/2018 01/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 02/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2018 01/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 02/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 02/01/2018 01/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 02/01/2018 11/29/2019

Services

Setting Begin/End DatesNon-Certified School Setting(s)12/14/2018 01/31/2020DOUDNA ELEMENTARY SCHOOL, 1990 BOHMANN DR, RICHLAND CENTER, WI 53581

2563RICHLAND COUNTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202002/01/201801/01/2005

(608) 647-6611

(608) [email protected] CULVER

County: RichlandRICHLAND CENTER, WI 53581221 W SEMINARY STREET

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 02/01/2018 01/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

ROCKBELOIT

1100BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201807/01/1985

(608) 363-5756

(608) [email protected] NEECE

County: RockBELOIT, WI 535111969 W HART ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI 535111

12/01/2018 11/30/2020JANESVILLE CLINIC, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI 535451

12/01/2018 11/30/2020CCC - BELOIT LEARNING ACADEMY, 1033 WOODWARD AVE, BELOIT, WI 535113

12/01/2018 11/30/2020CCC - BELOIT MEMORIAL HIGH SCHOOL, 1225 4TH STREET, BELOIT, WI 535113

3190COMMUNITY HEALTH SYSTEM BEHAVIORAL HEALTH

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202202/01/202002/01/2018

(608) 313-3119

(608) [email protected] BETH JOHNSON

County: RockBELOIT, WI 5351174 ECLIPSE CENTER

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022

Services

NO BRANCH LOCATIONS

1331FAMILY SERVICES OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/1981

(608) 365-4097

(608) [email protected] JELINEK

County: RockBELOIT, WI 53511416 COLLEGE STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

1804ROCK COUNTY HUMAN SERVICES DEPARTMENT - BELOIT COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201909/01/1989

(608) 363-6392

(608) [email protected] COTTINGTON

County: RockBELOIT, WI 5351164 ECLIPSE CENTER

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

JANESVILLE

1075ASSOCIATES IN PSYCHOTHERAPY, LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201808/01/1980

(608) 752-6942

(608) 752-7255carolannward@associatesinpsychotCAROL ANN WARD

County: RockJANESVILLE, WI 535464700 DRESSER DRIVE STE #100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

1809COMPASS BEHAVIORAL HEALTH CLINIC, A DIVISION OF RVCP

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/1990

(608) 741-4502

(608) [email protected] EGGERS

County: RockJANESVILLE, WI 53546203 W SUNNY LANE ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 10/09/2018 02/29/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020COMPASS BEHAVIORAL HEALTH CLINIC, 1820 CENTER AVE #170, JANESVILLE, WI 535462

1381GENESIS COUNSELING SERVICES LTD

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1988

(608) 757-2319

(608) [email protected] BURNS

County: RockJANESVILLE, WI 53545ONE S MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3002MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201905/18/2013

(608) 756-6564

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 53548903 MINERAL POINT AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2019 06/30/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1612MERCY OPTIONS - MERCY HEALTH SYSTEMS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201910/01/1984

(608) 741-6962

(608) [email protected] VINEY

County: RockJANESVILLE, WI 535481000 MINERAL POINT AVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/2019 06/30/2021

MENTAL HEALTH-INPATIENT DHS 61.71 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

1610MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/1993

(608) 756-0174

(608) [email protected] ROSE-BARAJAS

County: RockJANESVILLE, WI 53548903 MINERAL POINT ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021MERCY CLINIC NORTH, 3400 DEERFIELD DRIVE, JANESVILLE, WI 535461

01/01/2020 12/31/2021MERCY OPTIONS-OUTPATIENT SERVICES, 507 W MAIN ST, WHITEWATER, WI 531901

01/01/2020 12/31/2021MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI 535451

01/01/2020 12/31/2021MERCY BELOIT CLINIC, 2825 PRAIRIE AVENUE, BELOIT, WI 535112

01/01/2020 12/31/2021MERCY EVANSVILLE CLINIC, 300 UNION STREET, EVANSVILLE, WI 535362

01/01/2020 12/31/2021MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MERCYCARE, 580 N. WASHINGTON ST., JANESVILLE, WI 53548

2

01/01/2020 12/31/2021MERCY OPTIONS BH CLINIC - WALWORTH, N2846 STATE ROAD 67, WILLIAMS BAY, WI 531912

01/07/2020 12/31/2021CRAIG HIGH SCHOOL, 401 RANDALL AVENUE, JANESVILLE, WI 535453

01/07/2020 12/31/2021MILTON HIGH SCHOOL, 114 W HIGH STREET, MILTON, WI 535633

01/07/2020 12/31/2021MILTON MIDDLE SCHOOL, 448 E HIGH STREET, MILTON, WI 535633

01/07/2020 12/31/2021NORTHSIDE INTERMEDIATE SCHOOL, 159 NORTHSIDE DRIVE, MILTON, WI 535633

Setting Begin/End DatesNon-Certified School Setting(s)01/01/2020 12/31/2021PARKER HIGH SCHOOL, 3125 MINERAL POINT AVE, JANESVILLE, WI 53548

01/01/2020 12/31/2021WILSON ELEMENTARY SCHOOL, 465 ROCKPORT ROAD, JANESVILLE, WI 53548

2741MERCY OPTIONS CHILD AND ADOLESCENT DAY TREATMENT

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2007

(608) 758-5761

(608) [email protected] USGAARD

County: RockJANESVILLE, WI 535452600 HUMES RD, SUITE 100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 07/01/2019 06/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3030ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2014

(608) 757-5545

(608) [email protected] SINGER

County: RockJANESVILLE, WI 535461900 CENTER AVE

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

1807ROCK COUNTY COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201810/01/1975

(608) 757-5545

(608) [email protected] LAKE

County: RockJANESVILLE, WI 53548113 S FRANKLIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020ROCK COUTNY JOB CENTER, 1900 CENTER AVENUE, JANESVILLE, WI 535461

09/01/2018 08/31/2020COURT STREET BRANCH OFFICE, 303 W. COURT ST., JANESVILLE, WI 535482

09/01/2018 08/31/2020ROCK CNTY CNSLNG CTR - BELOIT BRANCH, 64 ECLIPSE CENTER, BELOIT, WI 535112

09/01/2018 08/31/2020ROCK CNTY CNSLNG CTR - HEALTHCARE CTR BRANCH, 3530 N COUNTY TRK HWY F, JANESVILLE, WI 53547

2

1803ROCK COUNTY HUMAN SERVICES CRISIS INTERVENTION UNIT

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201801/10/1975

(608) 758-8426

(608) [email protected] TRIMBLE

County: RockJANESVILLE, WI 535473530 N COUNTY HIGHWAY F

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

1805ROCK COUNTY HUMAN SERVICES DEPT JANESVILLE COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201909/01/1989

(608) 757-5545

(608) [email protected] COTTINGTON

County: RockJANESVILLE, WI 53548113 S FRANKLIN ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1265TRIVIUM DBA CROSSROADS COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201909/01/1977

(608) 755-5267

(608) [email protected] PERRY

County: RockJANESVILLE, WI 5354817 S RIVER STREET #254

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 10/01/2019 09/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier10/01/2019 09/30/2021CROSSROADS COUNSELING CENTER, 722-728 LOIS DRIVE, SUN PRAIRIE, WI 535901

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Mental Health Program Directory By County, City, and Provider Name

RUSKLADYSMITH

2948ACCESS, INC COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/06/2011

(715) 532-9774

(715) [email protected] WOLF

County: RuskLADYSMITH, WI 54848108 W 2ND STREET N

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2019 08/31/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 09/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

2691RUSK COUNTY HEALTH & HUMAN SERVICES/ACCESS, INC.

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/16/2006

(715) 532-2126

(715) [email protected] JACOBS

County: RuskLADYSMITH, WI 54848311 E MINER AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SAINT CROIXBALDWIN

2946WESTERN WISCONSIN HEALTH - BEHAVIORAL HEALTH SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/20/2011

(715) 684-1524

(715) [email protected] BABBITT

County: Saint CroixBALDWIN, WI 540021100 BERGSLIEN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020BALDWIN - WOODVILLE HIGH SCHOOL, 1000 13TH AVENUE, BALDWIN, WI 540023

07/01/2018 06/30/2020GREENFIELD ELEMENTARY SCHOOL, 1160 14TH AVENUE, BALDWIN, WI 540023

07/01/2018 06/30/2020VIKING MIDDLE SCHOOL, 500 SOUTHSIDE DRIVE, WOODVILLE, WI 540283

HUDSON

1173HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201909/01/1990

(715) 531-6766

(715) [email protected] BARTLETT

County: Saint CroixHUDSON, WI 54016405 STAGELINE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI 540161

2859MARRIAGE AND FAMILY HEALTH SERVICES, LTD.

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/2009

(715) 381-5438

(715) [email protected] SCHULZ-JOHNSTON

County: Saint CroixHUDSON, WI 540162910 ENLOE STREET UNIT 4

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

NEW RICHMOND

3073FAMILY THERAPY ASSOCIATES LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/04/2014

(715) 254-9459

(715) [email protected] MASON

County: Saint CroixNEW RICHMOND, WI 54017150 W FIRST ST SUITE 270

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021FAMILY THERAPY ASSOC, 250 S WASHINGTON ST, ST CROIX FALLS, WI 540242

12/01/2019 11/30/2021FAMILY THERAPY ASSOC, 3610 OAKWOOD MALL DR #204, EAU CLAIRE, WI 547012

12/01/2019 11/30/2021FAMILY THERAPY ASSOC, 700 WOLSKE BAY RD #140, MENOMONIE, WI 547512

Setting Begin/End DatesNon-Certified School Setting(s)12/01/2019 11/30/2021ALTOONA SCHOOL DISTRICT, 1930 BARTLETT AVE, ALTOONA, WI 54720

12/01/2019 11/30/2021BLOOMER SCHOOL DISTRICT, 1310 17TH AVE, BLOOMER, WI 54724

12/01/2019 11/30/2021BRUCE ELEM, MIDDLE, & HIGH SCHOOL, 104 W WASHINGTON AVE, BRUCE, WI 54819

12/01/2019 11/30/2021CAMERON SCHOOL DISTRICT, 600 WISCONSIN AVE, CAMERON, WI 54822

12/01/2019 11/30/2021COLFAX ELEM, MIDDLE, & HIGH SCHOOL, 601 UNIVERSITY AVE, COLFAX, WI 54730

12/01/2019 11/30/2021ELEVA-STRUM PUBLIC SCHOOL, W23597 US HIGHWAY 10, STRUM, WI 54770

12/01/2019 11/30/2021HUDSON SCHOOL DISTRICT, 644 BRAKKE DR, HUDSON, WI 54016

12/01/2019 11/30/2021LUCK ELEM, MIDDLE, & HIGH SCHOOL, 810 S 7TH ST, LUCK, WI 54853

12/01/2019 11/30/2021MENOMONIE SCHOOL DISTRICT, 2115 PINE AVE NE, MENOMONIE, WI 54751

12/01/2019 11/30/2021MONDOVI SCHOOL DISTRICT, 337 N JACKSON ST, MONDOVI, WI 54755

12/01/2019 11/30/2021OSCEOLA SCHOOLS, 331 MIDDLE SCHOOL DR, OSCEOLA, WI 54020

12/01/2019 11/30/2021OSSEO-FAIRCHILD, 50851 E ST, OSSEO, WI 54758

12/01/2019 11/30/2021SOMERSET SCHOOL DISTRICT, 625 SUNRISE DR, PO BOX 100, SOMERSET, WI 54025

12/01/2019 11/30/2021ST CROIX FALLS ELEMENTARY SCHOOL, 651 E LOUISIANA, ST CROIX FALLS, WI 54024

12/01/2019 11/30/2021ST CROIX FALLS MIDDLE & HIGH SCHOOL, 740 MAPLE DR, ST CROIX FALLS, WI 54024

12/01/2019 11/30/2021UNITY ELEMENTARY SCHOOL, 1908 150TH ST HIGHWAY 46N, BALSAM LAKE, WI 54810

12/01/2019 11/30/2021UNITY SCHOOL DISTRICT, 1908 150TH ST HIGHWAY 46 N, BALSAM LAKE, WI 54810

3110ST. CROIX COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES - CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/01/2016

(715) 246-8284

(715) [email protected] KIRT

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

CCS Affiliaton: 01/01/2019Begin: End: Lead:BESt CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2018 03/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 04/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1856ST. CROIX COUNTY HEALTH & HUMAN SERVICES - BEHAVIORAL HEALTH

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201801/01/1990

(715) 246-8284

(715) [email protected] HUSTON

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/01/2018 11/30/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 12/01/2018

11/29/2019

Services

NO BRANCH LOCATIONS

1855ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201810/01/1975

(715) 246-8284

(715) [email protected] KIRT

County: Saint CroixNEW RICHMOND, WI 540171752 DORSET LANE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 12/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/01/2018 11/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 12/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

3161WESTFIELDS HOSPITAL AND CLINIC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201912/01/2016

(715) 243-2901

(715) [email protected] BARTLETT

County: Saint CroixNEW RICHMOND, WI 54017535 HOSPITAL ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021AMERY HOSPITAL AND CLINIC, 265 GRIFFIN ST E, AMERY, WI 540011

12/01/2019 11/30/2021FREDERIC CLINIC, 201 OAK ST W, FREDERIC, WI 548371

12/01/2019 11/30/2021HUDSON HOSPITAL AND CLINIC, 405 STAGELINE RD, HUDSON, WI 540161

12/01/2019 11/30/2021OSCEOLA MEDICAL CENTER, 2600 65TH AVE, OSCEOLA, WI 540201

12/01/2019 11/30/2021ST CROIX REGIONAL MEDICAL CENTER, 235 E STATE ST, ST CROIX FALLS, WI 540241

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Mental Health Program Directory By County, City, and Provider Name

SAINT LOUISDULUTH

1628ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201809/01/1987

(218) 786-5922

(218) 727-8762diane.holliday-welsh@essentiahealtDIANE HOLLIDAY-WELSH

County: Saint LouisDULUTH, MN 55805502 EAST SECOND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 12/01/2018 11/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

2083ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201810/01/1998

(218) 786-2105

(218) [email protected] GERTSEMA

County: Saint LouisDULUTH, MN 55811615 PECAN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1423HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/01/1982

(715) 392-6055

(715) 392-8216

HANNAH WATERMAN

County: Saint LouisDULUTH, MN 558051401 E 1ST STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020HUMAN DEVELOPMENT CENTER, 1406 EAST 2ND STREET, DULUTH, MN 558051

07/01/2018 06/30/2020HUMAN DEVELOPMENT CENTER, 325 11TH AVENUE, TWO HARBORS, MN 556161

3023SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202202/01/202002/25/2014

(218) 722-0373

(218) 786-5990Diane.Holliday-Welsh@EssentiaheaDIANE HOLLIDAY-WELSH

County: Saint LouisDULUTH, MN 55805330 EAST 2ND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT DHS 61.75 02/01/2020 01/31/2022

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2999SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH CLINIC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/06/2013

(218) 722-0373

(218) 786-1186Diane.Holliday-Welsh@essentiaheaDIANE HOLLIDAY-WELSH

County: Saint LouisDULUTH, MN 55805502 EAST 2ND STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier06/19/2018 02/29/2020ESSENTIA HLTH DULUTH AMBERWING, 615 PECAN AVE, DULUTH, MN 558111

03/01/2018 02/29/2020ESSENTIA HLTH HERMANTOWN, 4855 W ARROWHEAD RD, HERMANTOWN, MN 558111

03/01/2018 02/29/2020ESSENTIA HLTH ST MARY'S HOSP & CLINIC SUPERIOR, 3500 TOWER AVENUE, SUPERIOR, WI 548801

12/03/2018 02/29/2020THE DULUTH CLINIC DBA ESSENTIA HLTH ASHLAND CLINIC, 1615 MAPLE LN STE 1, ASHLAND, WI 54806

1

1865ST. LUKE'S HOSPITAL

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/1995

(218) 249-2457

(218) [email protected] JANSON

County: Saint LouisDULUTH, MN 55805915 E. FIRST STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SAUKBARABOO

1436INNERVISIONS COUNSELING AND CONSULTING CENTER, SC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/19/2007

(877) 560-0578

(608) [email protected] JAMES

County: SaukBARABOO, WI 53913840 STATE ROAD 136, SUITE 1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020DELTON FAMILY MEDICAL CENTER, 28 COMMERCE ST, WISCONSIN DELLS, WI 539651

11/01/2018 10/31/2020INNERVISIONS COUNSELING & CONSULTING CENTER, 231 EAST STATE ST, MAUSTON, WI 539481

11/01/2018 10/31/2020NEW LISBON FAMILY MEDICAL CENTER, 901 WEST BRIDGE STREET, NEW LISBON, WI 539501

11/01/2018 10/31/2020INNERVISIONS COUNSELING & CONSULTING CENTER, 129 EAST BRIDGE STREET, NEW LISBON, WI 53950

2

11/01/2018 10/31/2020MILE BLUFF CLINIC, 1040 DIVISION ST., MAUSTON, WI 539482

11/01/2018 10/31/2020JACK YOUNG MIDDLE SCHOOL, 1531 DRAPER ST, BARABOO, WI 539133

11/01/2018 10/31/2020NECEDAH MIDDLE/HIGH SCHOOL, 1801 S MAIN STREET, NECEDAH, WI 546463

11/02/2018 10/31/2020NEW LISBON MIDDLE/HIGH SCHOOL, 500 S FOREST ST, NEW LISBON, WI 539503

11/01/2018 10/31/2020OLSON MIDDLE SCHOOL, 508 GRAYSIDE AVENUE, MAUSTON, WI 539483

11/01/2018 10/31/2020WEBB MIDDLE SCHOOL, 501 K ST, REEDSBURG, WI 539593

02/22/2019 10/31/2020WONEWOC-CENTER SCHOOL, 101 SCHOOL RD, WONEWOC, WI 539683

2713SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/2007

(608) 355-4299

(608) [email protected] ELLINWOOD

County: SaukBARABOO, WI 53913505 BROADWAY ST

CCS Affiliaton: 07/01/2014Begin: End: Lead:Wisconsin River CCS Collaboration

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2019 02/28/2021

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021SAUK COUNTY DEPT HUMAN SERVICES REEDSBURG, 425 - 6TH STREET, REEDSBURG, WI 539591

1824SAUK COUNTY DEPARMENT OF HUMAN SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/1988

(608) 355-4299

(608) [email protected] MIJAL

County: SaukBARABOO, WI 53913505 BROADWAY STREET

Service Begin/End DatesAdm Code

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

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021SAUK COUNTY DHS - REEDSBURG OFFICE, 425 SIXTH STREET, REEDSBURG, WI 539591

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Mental Health Program Directory By County, City, and Provider Name

3127TELLURIAN OUTPATIENT SERVICES

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201706/01/2016

(608) 222-6694

(608) [email protected] CROOKS

County: SaukBARABOO, WI 53913414 BROADWAY ST SUITE 101

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2017 05/31/2019

CSAS-INTERVENTION DHS 75.16 06/01/2017 05/31/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 06/01/2017 05/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2017 05/31/2019

Services

NO BRANCH LOCATIONS

PRAIRIE DU SAC

3138PATHWAY TO WELLNESS COMMUNITY CLINIC, LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201907/01/2016

(608) 370-8177

(608) [email protected] KIRCH

County: SaukPRAIRIE DU SAC, WI 53578560 4TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2019 06/30/2021BRIDGES ELEMENTARY SCHOOL, 1200 BROADWAY ST, PRAIRIE DU SAC, WI 53578

07/01/2019 06/30/2021GRAND AVENUE ELEMENTARY, 225 GRAND AVE, PRAIRIE DU SAC, WI 53578

07/01/2019 06/30/2021SAUK PRAIRIE HIGH SCHOOL, 105 NINTH ST, PRAIRIE DU SAC, WI 53578

REEDSBURG

2774GOODMAN'S BEHAVIORAL HEALTH CLINIC LLC

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/06/2008

(608) 768-4646

(608) [email protected] GOODMAN

County: SaukREEDSBURG, WI 539592213 E MAIN STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

1823SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Tina Dary

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/1990

(608) 524-7980

(608) [email protected] CIBULKA

County: SaukREEDSBURG, WI 53959425 SIXTH STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SAWYERHAYWARD

1486LAC COURTE ORIELLES BEHAVIORAL HEALTH

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201903/01/1987

(715) 634-6107

(715) [email protected] BERGUM

County: SawyerHAYWARD, WI 5484313447 W COUNTY HWY B STE 1

Service Begin/End DatesAdm Code

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

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

Services

NO BRANCH LOCATIONS

3160LCO CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201905/01/2017

(715) 558-7821

(715) [email protected] BERGUM

County: SawyerHAYWARD, WI 5484313447 W COUNTY RD B, STE 2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

2330NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201802/01/2001

(715) 634-2533

(715) [email protected] LUND

County: SawyerHAYWARD, WI 5484310270 OLKER ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

2213NORTHLAND COUNSELING SERVICES LTD

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201804/03/2000

(715) 634-1722

(715) [email protected] LUND

County: SawyerHAYWARD, WI 5484310752 BEAL STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3049NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - HAYWARD

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/16/2014

(175) 699-1243

(715) [email protected] MAURER

County: SawyerHAYWARD, WI 5484316092 US HIGHWAY 63

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 09/01/2019 08/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

09/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

1825SAWYER COUNTY HEALTH & HUMAN SERVICES/INFORMATION & REFERRAL CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201804/01/1979

(715) 634-3580

(715) [email protected] CARLSON

County: SawyerHAYWARD, WI 5484310610 MAIN ST SUITE 224

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-PREVENTION DHS 75.04 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020TRANSITION HOUSE, 16208 WOOD RIDGE LANE, HAYWARD, WI 548431

2998SAWYER COUNTY HUMAN SERVICES/NORTHLAND COUNSELING SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/01/2013

(715) 634-5019

(715) [email protected] G. GRAHOVAC

County: SawyerHAYWARD, WI 5484310270 OLKER ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SHAWANOBOWLER

1882STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201806/19/2014

(715) 793-1312

(715) [email protected] TORRES

County: ShawanoBOWLER, WI 54416W12802 COUNTY HWY A

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

NO BRANCH LOCATIONS

GRESHAM

1554MAEHNOWESEKIYAH WELLNESS CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201911/21/1989

(715) 799-5056

(715) [email protected] ANN DICK

County: ShawanoGRESHAM, WI 54128N2150 KESAEHKAHTEK

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

SHAWANO

1831SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202010/09/201903/01/1977

(715) 526-5542

(715) [email protected] FROST

County: ShawanoSHAWANO, WI 54166W7327 ANDERSON AVE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/09/2019 12/31/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 10/09/2019 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/09/2019 12/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 10/09/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/09/2019 12/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/09/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/09/2019 12/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 10/09/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2863SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202110/09/201905/06/2014

(715) 526-5542

(715) [email protected] THOUSAND

County: ShawanoSHAWANO, WI 54166W7327 ANDERSON AVE

CCS Affiliaton: 12/01/2014Begin: End: Lead:Lakeshore Recovery Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 10/09/2019 06/30/2021

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 10/09/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2242SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202010/09/201901/01/2000

(715) 526-5542

(715) [email protected] VAN ERT

County: ShawanoSHAWANO, WI 54166W7327 ANDERSON AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/09/2019 12/31/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 10/09/2019

12/01/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SHEBOYGANSHEBOYGAN

1925AURORA SHEBOYGAN CLINIC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202008/01/201807/01/1986

(920) 459-1483

(920) [email protected] LEE-JOHNSON

County: SheboyganSHEBOYGAN, WI 530812414 KOHLER MEMORIAL DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 08/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 08/13/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/13/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 06/30/2020AURORA HEALTH CENTER KIEL, 1001 SERVICE ROAD, KIEL, WI 530421

08/01/2018 06/30/2020AURORA HEALTH CENTER, 1815 ASHLAND AVE, SHEBOYGAN, WI 530812

08/01/2018 06/30/2020AURORA SHEBOYGAN CLINIC, 2600 KILEY WAY, PLYMOUTH, WI 530732

1835AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201805/01/1987

(920) 451-5123

(920) [email protected] KNITT

County: SheboyganSHEBOYGAN, WI 530832629 N 7TH STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 05/01/2018 04/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

3171AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER-AURORA BEHAVIORAL HEALTH CENTER

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201812/26/2016

(920) 453-3901

(920) [email protected] KUHN

County: SheboyganSHEBOYGAN, WI 530811221 N 26TH STREET

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 05/01/2018 04/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1133CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC.

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201904/01/1983

(920) 458-5826

(920) [email protected] BIBO

County: SheboyganSHEBOYGAN, WI 53081503 WISCONSIN AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 04/30/2021CATHOLIC CHARITIES ARCHDIOCESE OF MILW INC, 191 S MAIN STREET, FOND DU LAC, WI 549351

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Mental Health Program Directory By County, City, and Provider Name

3214COMMUNITY CONSULTANTS, INC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/201906/01/201806/01/2018

(920) 351-4971

(920) 447-4545jamessimac@communityconsultantsJAMES SIMAC

County: SheboyganSHEBOYGAN, WI 530811504 NEW JERSEY AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2019

Services

NO BRANCH LOCATIONS

2869LEPAK JOSTSONS INC DBA DYNAMIC FAMILY SOLUTIONS

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201808/19/2009

(920) 358-5970

(920) [email protected] A LEPAK JOSTSONS

County: SheboyganSHEBOYGAN, WI 53081615 SOUTH 8TH ST SUITE 220

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2019

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2018 08/31/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2018 08/31/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2020DYNAMIC FAMILY SOLUTIONS STURGEON BAY, 101 N 4TH AVE, STURGEON BAY, WI 542351

09/01/2019 08/31/2020DYNAMIC FAMILY SOLUTIONS, 3021 HOLMGREN WAY, GREEN BAY, WI 543051

09/01/2019 08/31/2020DYNAMIC FAMILY SOLUTIONS, ONE WALDO BLVD, STE 3, MANITOWOC, WI 542201

1656NETT-WORK FAMILY COUNSELING, LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201802/27/1998

(920) 458-6439

(920) [email protected] M. NETT

County: SheboyganSHEBOYGAN, WI 530832801 CALUMET DRIVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 1011 - 10TH STREET #1, MANITOWOC, WI 542201

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 1403 MILWAUKEE DR, NEW HOLSTEIN, WI 530611

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING LLC, 621 E MILL ST, PLYMOUTH, WI 530731

03/01/2018 02/29/2020NETT-WORK FAMILY COUNSELING, LLC, 3321 SOUTH 12TH ST, SHEBOYGAN, WI 530812

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Mental Health Program Directory By County, City, and Provider Name

1699NORTHSHORE CLINIC LLC

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201808/01/1991

(920) 457-8867

(920) [email protected] DIELENTHEIS

County: SheboyganSHEBOYGAN, WI 53081805 NORTH 6TH STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Setting Begin/End DatesNon-Certified School Setting(s)03/01/2018 02/29/2020JEFFERSON ELEMENTARY SCHOOL, 1538 N 15TH ST, SHEBOYGAN, WI 53081

01/15/2019 02/29/2020LONGFELLOW ELEMENTARY SCHOOL, 819 KENTUCKY AVE, SHEBOYGAN, WI 53081

3194SHEBOYGAN CO HEALTH AND HUMAN SERVICES CSP

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201901/29/2018

(920) 459-4353

(920) [email protected] KREPSKY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 02/01/2019 01/31/2021

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 02/01/2019

11/29/2019

Services

NO BRANCH LOCATIONS

1834SHEBOYGAN COUNTY DEPT OF HEALTH AND HUMAN SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201807/01/1986

(920) 459-4353

(920) 459-3207jaclyn.moglowsky@sheboygancounJACKIE MOGLOWSKY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 10/01/2018 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 10/01/2018 09/30/2020

Services

NO BRANCH LOCATIONS

2667SHEBOYGAN COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/01/2006

(920) 459-4353

(920) [email protected] KREPSKY

County: SheboyganSHEBOYGAN, WI 530811011 N 8TH STREET

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 06/01/2018 05/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 07/10/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3070ST. NICHOLAS HOSPITAL DBA PREVEA HEALTH

Surveyor: Renee DeWitt

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201910/27/2014

(920) 272-1201

(920) [email protected] TUTSKEY

County: SheboyganSHEBOYGAN, WI 530813425 SUPERIOR AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2019 11/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 11/30/2021PREVEA HEALTH KOHLER, 950 WOODLAKE RD, KOHLER, WI 530441

12/01/2019 11/30/2021VOLLRATH HEALTH AND WELLNESS CLINIC, 1236 N 18TH ST, SHEBOYGAN, WI 530811

12/01/2019 11/30/2021PREVEA PLYMOUTH HEALTH CENTER, 825 WALTON DR, PLYMOUTH, WI 530732

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Mental Health Program Directory By County, City, and Provider Name

TAYLORMEDFORD

1577ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201901/01/1978

(715) 442-7731

(715) [email protected] WILLIAMS

County: TaylorMEDFORD, WI 54451143 SOUTH GIBSON ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021ASPIRUS PHILLIPS CLINIC, 625 PETERSON AVE, PHILLIPS, WI 545551

09/01/2019 08/31/2021ASPIRUS PRENTICE CLINIC, 1511 RAILROAD AVE, PRENTICE, WI 545561

2753COUNSELING CONNECTION OF MEDFORD, LLC

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/2007

(715) 748-4407

(715) [email protected] SCHULTZ

County: TaylorMEDFORD, WI 54451429 W BROADWAY AVE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021PHOENIX HOUSE, 600 W HICKORY ST, GILMAN, WI 544331

09/01/2019 08/31/2021MEDFORD ADULT DIPLOMA ACADEMY & ALT ED PROGRAM, 624 E COLLEGE ST, MEDFORD, WI 54451

3

09/01/2019 08/31/2021MEDFORD ELEMENTARY SCHOOL-COUNSELING CONNECTION, 1065 W BROADWAY AVE, MEDFORD, WI 54451

3

09/01/2019 08/31/2021MEDFORD HIGH SCHOOL-COUNSELING CONNECTION, 1015 W BROADWAY AVE, MEDFORD, WI 54451

3

09/01/2019 08/31/2021MEDFORD MIDDLE SCHOOL-COUNSELING CONNECTION, 509 CLARK ST, MEDFORD, WI 544513

10/01/2019 08/31/2021RIB LAKE ELEMENTARY SCHOOL, 1236 KENNEDY ST, RIB LAKE, WI 544703

10/01/2019 08/31/2021RIB LAKE MIDDLE SCHOOL, 1296 NORTH ST, RIB LAKE, WI 544703

09/01/2019 08/31/2021STETSONVILLE ELEMENTARY SCHOOL, W5338 COUNTY RD A, STETSONVILLE, WI 544803

3193NORTH CENTRAL REGION CCS PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2018

(715) 748-3342

(715) [email protected] KETELHUT

County: TaylorMEDFORD, WI 54451540 E COLLEGE STREET

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021IRON COUNTY HUMAN SERVICES & ASSOC, 300 TACONITE STREET, STE 201, HURLEY, WI 545341

01/01/2020 12/31/2021PRICE COUNTY HEALTH AND HUMAN SVS, 104 SOUTH EYDER, PHILLIPS, WI 545551

01/01/2020 12/31/2021SAWYER COUNTY HEALTH AND HUMAN SVS, 10610 MAIN STREET, STE 224, HAYWARD, WI 548431

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Mental Health Program Directory By County, City, and Provider Name

1898TAYLOR COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201806/01/1982

(715) 748-3342

(715) [email protected] MEYER

County: TaylorMEDFORD, WI 54451540 E. COLLEGE STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

TREMPEALEAUWHITEHALL

3170TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201903/01/2017

(715) 538-4274

(715) [email protected] SUCHLA

County: TrempealeauWHITEHALL, WI 5477336245 MAIN STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 03/01/2019 02/29/2020

Services

NO BRANCH LOCATIONS

3094TREMPEALEAU COUNTY HUMAN SERVICES - CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/2015

(715) 538-4174

(715) [email protected] SUCHLA

County: TrempealeauWHITEHALL, WI 5477336245 MAIN ST

CCS Affiliaton: 09/01/2015Begin: End: Lead:CCS of Clark and Trempealeau Counties

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

2543WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202110/07/201909/03/2004

(715) 538-9496

(715) [email protected] PYKA

County: TrempealeauWHITEHALL, WI 54773N36647 COUNTY ROAD QQQ

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/07/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 10/07/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/07/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/07/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

VERNONHILLSBORO

3145GUNDERSEN ST JOSEPH'S HOSPITAL & CLINICS-HILLSBORO CLINIC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201808/26/2016

(608) 489-8181

(608) [email protected] MCCOIC

County: VernonHILLSBORO, WI 54634400 WATER AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2018 08/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2018 08/31/2020GUNDERSEN ST JOSEPH'S HOSP & CLINICS-ELROY, 1705 OMAHA, ELROY, WI 539291

09/01/2018 08/31/2020GUNDERSEN ST JOSEPH'S HOSP & CLINICS-WONEWOC, 301 RAILROAD ST, WONEWOC, WI 539681

VIROQUA

1317FAMILY AND CHILDREN'S CENTER, INC. COMMUNITY SUPPORT PROGRAM

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201901/01/1996

(608) 637-8500

(608) [email protected] HOWE

County: VernonVIROQUA, WI 546651321 N MAIN ST

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

3092STRIVE COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/01/2015

(608) 637-5505

(608) [email protected] EITLAND

County: VernonVIROQUA, WI 54665318 FAIRLANE DRIVE SUITE 100

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL MULTI-COUNTY DHS 36 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020CRAWFORD CO DEPT. OF HUMAN SERVICES, 225 N. BEAUMONT RD SUITE 326, PRAIRIE DU CHIEN,

WI 538212

WESTBY

2565HIDDEN SPRINGS CLINIC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/09/2004

(608) 634-6918

(608) [email protected] JENSEN

County: VernonWESTBY, WI 54667S 1597 HANSON ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

VILASLAC DU FLAMBEAU

1325FAMILY RESOURCE CENTER

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/1988

(715) 588-3903

(715) [email protected] STEBER

County: VilasLAC DU FLAMBEAU, WI 54538533 PEACE PIPE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 09/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021DOMESTIC ABUSE PROGRAM, 157 CEDAR AVE, LAC DU FLAMBEAU, WI 545381

09/16/2019 08/31/2021ARBOR VITAE-WOODRUFF ELEMENTARY, 11065 OLD HWY 51 N, ARBOR VITAE, WI 545683

09/01/2019 08/31/2021LAC DU FLAMBEAU PUBLIC SCHOOL, 2899 HIGHWAY 47, LAC DU FLAMBEAU, WI 545383

09/01/2019 08/31/2021LAKELAND UNION HIGH SCHOOL, 9573 STATE HIGHWAY 70, MINOCQUA, WI 545483

3100GOOKOMIS ENDAAD

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201901/19/2016

(715) 588-1889

(715) [email protected] THOMPSON

County: VilasLAC DU FLAMBEAU, WI 545383378 N SCHILLEMAN RD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

3071LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202202/01/202002/01/2015

(715) 588-3903

(715) [email protected] BUESING

County: VilasLAC DU FLAMBEAU, WI 54538533 PEACE PIPE ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 02/01/2020 01/31/2022

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WALWORTHDELAVAN

3200LAKESIDE COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/17/2018

(262) 757-7543

(262) [email protected] LINDSKOG

County: WalworthDELAVAN, WI 531151624 HOBBS DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

ELKHORN

1262CREDENCE THERAPY ASSOCIATES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/19/1995

(262) 723-8308

(262) [email protected] STEEN

County: WalworthELKHORN, WI 531211-1/2 W. GENEVA STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020BADGER HIGH SCHOOL, 220 E. SOUTH STREET, LAKE GENEVA, WI 531473

12/01/2018 11/30/2020BIG FOOT HIGH SCHOOL, 401 DEVILS LANE PO BOX 89, WALWORTH, WI 531843

12/01/2018 11/30/2020CENTRAL-DENISON ELEMENTARY, 900 WISCONSIN ST, LAKE GENEVA, WI 531473

12/01/2018 11/30/2020EASTVIEW ELEMENTARY, 535 SAGE ST, LAKE GENEVA, WI 531473

12/01/2018 11/30/2020ELKHORN AREA HIGH SCHOOL, 482 EAST GENEVA STREET, ELKHORN, WI 531213

12/01/2018 11/30/2020ELKHORN AREA MIDDLE SCHOOL, 627 EAST COURT ST., ELKHORN, WI 531213

12/01/2018 11/30/2020JACKSON ELEMENTARY SCHOOL, 13 NORTH JACKSON STREET, ELKHORN, WI 531213

12/01/2018 11/30/2020LAKE GENEVA MIDDLE SCHOOL, 600 BLOOMFIELD ROAD, LAKE GENEVA, WI 531473

12/01/2018 11/30/2020TIBBETS ELEMENTARY SCHOOL, W5218 COUNTY ROAD A, ELKHORN, WI 531213

12/01/2018 11/30/2020WEST SIDE ELEMENTARY SCHOOL, 222 SUNSET DRIVE, ELKHORN, WI 531213

2694WALWORTH COUNTY DEPT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/09/201911/08/2006

(262) 741-3217

(262) [email protected] ALDRED

County: WalworthELKHORN, WI 531211910 COUNTY ROAD NN

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 12/09/2019 11/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2889WALWORTH COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202112/09/201901/20/2010

(262) 741-3217

(262) [email protected] BROLL

County: WalworthELKHORN, WI 531211910 COUNTY ROAD NN

CCS Affiliaton: 08/01/2014Begin: End: Lead:JRW Tri County Regional CCS

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 12/09/2019 01/31/2021

Services

NO BRANCH LOCATIONS

1967WALWORTH COUNTY HEALTH AND HUMAN SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202012/09/201910/01/1975

(262) 741-3217

(262) [email protected] HEINRICH

County: WalworthELKHORN, WI 531211910 COUNTY ROAD NN

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 12/09/2019 08/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/09/2019 08/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 12/09/2019 08/31/2020

Services

NO BRANCH LOCATIONS

LAKE GENEVA

2517AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES - LAKE GENEVA

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201902/01/2004

(262) 249-7132

(414) [email protected] VALENTIN

County: WalworthLAKE GENEVA, WI 53147146 E GENEVA SQUARE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2019 01/31/2021AURORA HEALTH CENTER - WALWORTH, 525 KENOSHA ST, WALWORTH, WI 531841

02/01/2019 01/31/2021AURORA HEALTH CENTER - DELAVAN, 1550 HOBBS DR, DELAVAN, WI 531152

02/01/2019 01/31/2021AURORA HEALTH CENTER - ELKHORN, 201 E MORRISEY DR, ELKHORN, WI 531212

1492LAKE GENEVA WELLNESS CLINIC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201902/01/1984

(262) 248-1202

(262) [email protected] ARMSTRONG

County: WalworthLAKE GENEVA, WI 53147101 BROAD STREET, #201

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2019 03/31/2021WHEATLAND CENTER SCHOOL, 6606 368TH AVE, BURLINGTON, WI 53105

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Mental Health Program Directory By County, City, and Provider Name

WASHBURNSHELL LAKE

2506SOAR SERVICES, INC.

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202004/01/201803/11/2004

(715) 468-2374

(715) [email protected] MELTON

County: WashburnSHELL LAKE, WI 54871246 INDUSTRIAL BLVD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2018 03/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier09/10/2018 03/31/2020SOAR SERVICES, INC, 24670 STATE ROAD 35/70, STE 700, SIREN, WI 548722

07/18/2019 03/31/2020SOAR SERVICES, INC, 370 3RD AVE SO, PARK FALLS, WI 545522

04/01/2018 03/31/2020SOAR SERVICES, INC, 517 BEASER AVENUE, ASHLAND, WI 548062

Setting Begin/End DatesNon-Certified School Setting(s)04/01/2018 03/31/2020ASHLAND SCHOOLS, 2000 BEASER AVE, ASHLAND, WI 54806

04/01/2018 03/31/2020BARRON SCHOOL, 100 WEST RIVER AVE, BARRON, WI 54812

04/01/2018 03/31/2020BIRCHWOOD SCHOOL, 300 S. WILSON ST, BIRCHWOOD, WI 54817

04/01/2018 03/31/2020CHEQUAMAGON SCHOOL, 420 9TH ST NORTH, EISENSTEIN, WI 54552

04/01/2018 03/31/2020SHELL LAKE SCHOOLS, 271 HWY 63, SHELL LAKE, WI 54871

04/01/2018 03/31/2020SPOONER SCHOOLS, 801 CO. HWY A, SPOONER, WI 54801

2926WASHBURN COUNTY COMMUNITY SUPPORT PROGRAM

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2010

(715) 468-1588

(715) [email protected] SCHRANKEL

County: WashburnSHELL LAKE, WI 54871600 E COUNTY ROAD B

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

SPOONER

2631ACCESS, INC.

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2006

(715) 635-4861

(715) [email protected] WOLF

County: WashburnSPOONER, WI 548014851 HWY 63 SOUTH

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 1302 ARLEN CT, EAU CLAIRE, WI 547031

01/01/2020 12/31/2021ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 406 TECHNOLOGY DR. E SIUITE C, MENOMONIE, WI 54751

1

01/01/2020 12/31/2021AURORA COMMUNITY COUNSELING- PHILLIPS, 171 CHESTNUT ST., PHILLIPS, WI 545551

01/01/2020 12/31/2021ACCESS, INC - LADYSMITH, 108 W. 2ND STREET N, LADYSMITH, WI 548482

01/01/2020 12/31/2021ACCESS, INC. - SIREN, 24248 STATE HWY 35/70, UNIT D, SIREN, WI 548722

01/01/2020 12/31/2021ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 345 FRENETTE DR STE 3, CHIPPEWA FALLS, WI 54729

2

01/01/2020 12/31/2021CADOTT MIDDLE SCHOOL AND HIGH SCHOOL, 426 MYRTLE ST, CADOTT, WI 547273

01/01/2020 12/31/2021FLAMBEAU HIGH SCHOOL, N 4540 COUNTY HIGHWAY I, TONY, WI 545633

01/01/2020 12/31/2021GRANTSBURG SCHOOL, 480 E JAMES AVE, GRANTSBURG, WI 548403

01/01/2020 12/31/2021LADYSMITH ELEMENTARY SCHOOL, 115 E 6TH ST S, LADYSMITH, WI 548483

01/01/2020 12/31/2021LADYSMITH MIDDLE/HIGH SCHOOL, 1700 EDGEWOOD AVE E, LADYSMITH, WI 548483

01/01/2020 12/31/2021SPOONER ELEMENTARY SCHOOL, 1821 SCRIBNER ST, SPOONER, WI 548013

01/01/2020 12/31/2021SPOONER HIGH SCHOOL, 801 COUNTY HIGHWAY A, SPOONER, WI 548013

01/01/2020 12/31/2021SPOONER MIDDLE SCHOOL, 750 OAK ST, SPOONER, WI 548013

3198WHOLE LIFE SERVICES

Surveyor: Rena Andersen

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201904/23/2018

(715) 645-0336

(715) [email protected] EHRICH

County: WashburnSPOONER, WI 54801819 ASH STREET STE SO2O

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 03/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier04/01/2019 03/31/2021WHOLE LIFE SERVICES, 7726 RASMUSSEN ST, SIREN, WI 548721

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WASHINGTONGERMANTOWN

1199WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC DBA CHRISTIAN FAMILY SOLUTIONS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/1987

(262) 345-5562

(800) [email protected] SEMMANN

County: WashingtonGERMANTOWN, WI 53022W175 N11120 STONEWOOD DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 12/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020WLCFS - CHRISTIAN FAMILY SOLUTIONS, 112 PEACE LUTHERAN PKWY, HARTFORD, WI 530271

12/01/2018 11/30/2020WLCFS - CHRISTIAN FAMILY SOLUTIONS, 9215 W WISCONSIN AVE, MILWAUKEE, WI 532261

12/01/2018 11/30/2020GARDEN HOMES LUTHERAN SCHOOL, 2450 W ROOSEVELT DR, MILWAUKEE, WI 532093

12/01/2018 11/30/2020HOPE CHRISTIAN SCHOOL - FIDELIS, 4200 DOUGLAS AVE, MILWAUKEE, WI 532093

12/01/2018 11/30/2020HOPE CHRISTIAN SCHOOL - FORTIS, 3601 N PORT WASHINGTON RD, MILWAUKEE, WI 532123

12/01/2018 11/30/2020HOPE CHRISTIAN SCHOOL - PRIMA, 2345 N 25TH ST, MILWAUKEE, WI 532063

12/01/2018 11/30/2020HOPE CHRISTIAN SCHOOL - SEMPER, 3040 W CAPITOL DR, MILWAUKEE, WI 532163

12/01/2018 11/30/2020KETTLE MORAINE LUTHERAN HIGH SCHOOL, 3399 DIVISION RD, JACKSON, WI 530373

12/01/2018 11/30/2020LUMIN - NORTHWEST LUTHERAN, 4119 N 81ST ST, MILWAUKEE, WI 532223

12/01/2018 11/30/2020LUMIN - ST MARTINI LUTHERAN SCHOOL, 1520 S CESAR CHAVEZ DR, MILWAUKEE, WI 532043

12/01/2018 11/30/2020MT LEBANON LUTHERAN SCHOOL - ALPHA, 6100 WEST HAMPTON AVE, MILWAUKEE, WI 532183

12/01/2018 11/30/2020MT LEBANON LUTHERAN SCHOOL - OMEGA, 8444 W MELVINA ST, MILWAUKEE, WI 532223

12/01/2018 11/30/2020RISEN SAVIOR LUTHERAN SCHOOL, 9550 W BROWN DEER RD, MILWAUKEE, WI 532243

12/01/2018 11/30/2020SHINING STAR CHRISTIAN SCHOOL - FAIRVIEW, 137 N 66TH ST, MILWAUKEE, WI 532133

12/01/2018 11/30/2020SHINING STAR CHRISTIAN SCHOOL - WEST CAPITOL, 4050 N 95TH ST, MILWAUKEE, WI 532223

12/01/2018 11/30/2020SHORELAND LUTHERAN HIGH SCHOOL, 9026 12TH STREET, SOMERS, WI 531713

12/01/2018 11/30/2020ST JOHN'S GLENDALE LUTHERAN SCHOOL, 7877 N PORT WASHINGTON RD, GLENDALE, WI 532173

12/01/2018 11/30/2020ST LUCAS LUTHERAN SCHOOL, 648 E DOVER ST, MILWAUKEE, WI 532073

12/01/2018 11/30/2020ST MARCUS LUTHERAN SCHOOL - MAIN, 2215 N PALMER ST, MILWAUKEE, WI 532123

12/01/2018 11/30/2020ST MARCUS LUTHERAN SCHOOL - NORTH, 2669 N RICHARDS ST, MILWAUKEE, WI 532123

12/01/2018 11/30/2020ST PHILIP LUTHERAN SCHOOL, 3012 N HOLTON ST, MILWAUKEE, WI 532123

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Mental Health Program Directory By County, City, and Provider Name

STILLWATER

1342FAMILYMEANS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201802/01/1989

(651) 439-4894

(651) [email protected] ROWLSON

County: WashingtonSTILLWATER, MN 550821875 NORTHWESTERN AVENUE, S.

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020FAMILYMEANS, 2217 VINE STREET #105, HUDSON, WI 540162

05/01/2018 04/30/2020HUDSON PHYSICIANS, 403 STAGELINE ROAD, HUDSON, WI 540162

05/01/2018 04/30/2020EP ROCK ELEMENTARY SCHOOL, 340 13TH ST. N, HUDSON, WI 540163

05/01/2018 04/30/2020HILLSIDE ELEMENTARY, 635 E RICHMOND WAY, NEW RICHMOND, WI 540173

05/01/2018 04/30/2020HUDSON MIDDLE SCHOOL, 1300 CARMICHAEL RD, HUDSON, WI 540163

05/01/2018 04/30/2020MALONE ELEMENTARY, 1220 ST CROIX STREET, PRESCOTT, WI 540213

05/01/2018 04/30/2020NEW RICHMOND HIGH SCHOOL, 650 RICHMOND WAY, NEW RICHMOND, WI 540173

05/01/2018 04/30/2020NEW RICHMOND MIDDLE SCHOOL, 920 RILEY AVE, NEW RICHMOND, WI 540173

05/01/2018 04/30/2020NORTH HUDSON ELEMENTARY, 510 LEMON ST NORTH, HUDSON, WI 540163

05/01/2018 04/30/2020PAPERJACK ELEMENTARY, 1101 E 11TH STREET, NEW RICHMOND, WI 540173

05/01/2018 04/30/2020PRESCOTT HIGH SCHOOL, 1010 DEXTER ST, PRESCOTT, WI 540213

05/01/2018 04/30/2020PRESCOTT MIDDLE SCHOOL, 125 N ELM STREET, PRESCOTT, WI 540213

05/01/2018 04/30/2020STARR ELEMENTARY, 967 S STARR AVE, NEW RICHMOND, WI 540173

05/01/2018 04/30/2020WILLOW RIVER ELEMENTARY, 1118 4TH ST, HUDSON, WI 540163

WEST BEND

1017AFFILIATED CLINICAL SERVICES INC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201810/01/1984

(262) 338-9767

(262) [email protected] FEUCHT

County: WashingtonWEST BEND, WI 53095111 E WASHINGTON STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020AFFILIATED CLINICAL SERVICES INC, 38 SELL DRIVE #B, HARTFORD, WI 530272

Setting Begin/End DatesNon-Certified School Setting(s)07/01/2018 06/30/2020BADGER MIDDLE SCHOOL, 727 S 6TH AVE, ROOM #112, WEST BEND, WI 53095

07/01/2018 06/30/2020WEST BEND EAST & WEST HIGH SCHOOL, 1305 E DECORAH RD, RM N 15, WEST BEND, WI 53095

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Mental Health Program Directory By County, City, and Provider Name

3009ALARUS HEALTHCARE, LLC

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202004/01/201910/08/2013

(262) 377-6289

(608) [email protected] JOHNSON

County: WashingtonWEST BEND, WI 530951622 CHESTNUT ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 04/01/2019 09/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 04/01/2019 09/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/01/2019 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/11/2019 09/30/20204TH DIMENSION SOBER LIVING, 2838 N WEIL ST, MILWAUKEE, WI 532122

04/01/2019 09/30/2020ALARUS HEALTHCARE - BEAVER DAM, 111 WARREN ST #2, BEAVER DAM, WI 539162

04/01/2019 09/30/2020ALARUS HEALTHCARE - GRAFTON, 1971 WASHINGTON ST STE 200, GRAFTON, WI 530242

05/14/2019 09/30/2020WEST BEND HIGH SCHOOL, 1305 E DECORAH RD, WEST BEND, WI 530953

3234KETTLE MORAINE COUNSELING

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/29/202012/01/201911/28/2018

(262) 334-4341

(262) [email protected] MARSHALL

County: WashingtonWEST BEND, WI 53090400 W RIVER DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 12/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2019 12/29/2020KETTLE MORAINE COUNSELING, W62N281 WASHINGTON AVE, CEDARBURG, WI 530122

12/01/2019 12/29/2020KETTLE MORAINE COUNSILING, 7280 S 13TH ST SUITE 103, OAK CREEK, WI 531542

Setting Begin/End DatesNon-Certified School Setting(s)12/01/2019 12/29/2020MCLANE ELEMENTARY SCHOOL, 833 CHESTNUT ST, WEST BEND, WI 53095

12/01/2019 12/29/2020SILVERBROOK MIDDLE SCHOOL, 120 N SILVERBROOK DR, WEST BEND, WI 53095

12/01/2019 12/29/2020SLINGER SCHOOL DISTRICT, 207 POLK ST, SLINGER, WI 53086

12/01/2019 12/29/2020SLINGER SCHOOL DISTRICT, 521 OLYMPIC DR, SLINGER, WI 53086

1968WASHINGTON COUNTY MENTAL HEALTH CENTER

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201910/01/1975

(262) 335-6827

(262) [email protected] LESLIE

County: WashingtonWEST BEND, WI 53095333 E WASHINGTON ST #2100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 05/01/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2303WASHINGTON COUNTY MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201910/01/1975

(262) 335-6827

(262) [email protected] LESLIE

County: WashingtonWEST BEND, WI 53095333 E. WASHINGTON ST SUITE 2100

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

2580WASHINGTON COUNTY MENTAL HEALTH CENTER COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/2005

(262) 335-6827

(262) [email protected] LESLIE

County: WashingtonWEST BEND, WI 53095333 E WASHINGTON STREET, #2100

CCS Affiliaton: 01/01/2015Begin: End: Lead:Lakeshore Recovery Collaborative

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 03/01/2018 02/29/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WAUKESHABROOKFIELD

2654ASCENSION SE WI HOSPITAL, INC ST JOSEPH BEHAVIORAL HEALTH II

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201907/22/2005

(414) 874-6291

(414) [email protected] HESS

County: WaukeshaBROOKFIELD, WI 5300513950 W CAPITOL DR 2ND FLOOR

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021ASCENSION - ELMBROOK HOSPITAL, 19333 W NORTH AVE #304, BROOKFIELD, WI 530451

1237CORNERSTONE COUNSELING SERVICES, INC.

Surveyor: Kelley Clark

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/29/202003/01/201803/01/1993

(262) 821-6180

(262) [email protected] ADAMS

County: WaukeshaBROOKFIELD, WI 5300516535 W. BLUEMOUND ROAD, #200

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2018 02/29/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2018 02/29/2020

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 350, MILWAUKEE,

WI 532072

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 10850 W PARK PLACE, #100, MILWAUKEE, WI 532242

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 11649 N PORT WASHINGTON RD, #201, MEQUON, WI 53092

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 1230 CORPORATE CENTER DR, STE 100, OCONOMOWOC, WI 53066

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 400 BAY VIEW ROAD, SUITE C, MUKWONAGO, WI 53149

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 4811 S 76TH ST #208, GREENFIELD, WI 532202

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 5555 N PORT WASHINGTON ROAD, #200, GLENDALE, WI 53217

2

03/01/2018 02/29/2020CORNERSTONE COUNSELING SERVICES, INC., 741 N GRAND AVENUE, #302, WAUKESHA, WI 531862

12/11/2018 02/29/2020MUKWONAGO HIGH SCHOOL, 605 W VETERANS WAY, MUKWONAGO, WI 531493

2692FAMILY OPTIONS COUNSELING, LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/02/2006

(414) 431-0858

(414) [email protected] YOUNG

County: WaukeshaBROOKFIELD, WI 530053505 NORTH 124TH ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1730PATHWAYS COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201912/01/1985

(262) 641-9791

(262) [email protected] BEDRIN

County: WaukeshaBROOKFIELD, WI 5300513105 W. BLUEMOUND ROAD, #100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

2461WISCONSIN EARLY AUTISM PROJECT, INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/20/2003

(608) 662-9041

(608) [email protected] THOMPSON

County: WaukeshaBROOKFIELD, WI 53005150 N. SUNNYSLOPE RD SUITE 100

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 05/31/2020WISCONSIN EARLY AUTISM PROJECT DEPERE, 1141 W MAIN AVE STE 201, DE PERE, WI 541151

05/01/2019 05/31/2020WISCONSIN EARLY AUTISM PROJECT EAU CLAIRE, 2125 HEIGHTS DR STE 2F, EAU CLAIRE, WI 54701

1

05/01/2019 05/31/2020WISCONSIN EARLY AUTISM PROJECT MADISON, 1210 FOURIER DR, MADISON, WI 537171

3177WLCFS DBA CHRISTIAN FAMILY SOLUTIONS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201807/05/2017

(262) 345-5562

(800) [email protected] SEMMANN

County: WaukeshaBROOKFIELD, WI 5300516535 W BLUEMOUND RD SUITE 305

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 08/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/2018 07/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2019 07/31/2020WISCONSIN LUTHERAN COLLEGE, 8800 BLUEMOUND ROAD, MILWAUKEE, WI 532262

ELM GROVE

2734APPLIED THERAPIES AND WELLNESS CENTER SC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201805/30/2007

(414) 302-1234

(414) 302-1233twollin@appliedtherapiesandwellnesTRISHA WOLLIN

County: WaukeshaELM GROVE, WI 5312212970 W BLUEMOUND RD, #304

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1297ELMBROOK FAMILY COUNSELING CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/01/1978

(262) 785-0644

(262) 785-9188info@elmbrookfamilycounselingcentHOWARD J HAVEN

County: WaukeshaELM GROVE, WI 5312213000 W BLUEMOUND RD #300

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

MENOMONEE FALLS

2688DOMINION BEHAVIORAL HEALTH SERVICES, LLC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201911/01/2006

(262) 252-7567

(262) [email protected] DIXON

County: WaukeshaMENOMONEE FALLS, WI 53051W132 N6303 MARACH ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

NO BRANCH LOCATIONS

2076FROEDTERT & THE MEDICAL COLLEGE OF WI-COMMUNITY MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202009/01/201810/01/1982

(262) 257-2570

(262) [email protected] JONES

County: WaukeshaMENOMONEE FALLS, WI 53051W180 N8085 TOWN HALL ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2018 08/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2018 08/31/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 05/06/2019 08/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2018 08/31/2020

Services

NO BRANCH LOCATIONS

1579FROEDTERT PHYSICIANS PARTNERS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201902/01/1981

(262) 532-9585

(262) [email protected] GRANCORVITZ

County: WaukeshaMENOMONEE FALLS, WI 53051W129 N 7055 NORTHFIELD DR 3RD FL BLDG A

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2019 10/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2019 10/31/2021FROEDTERT AND MED COLLEGE PHY PARTNERS SUNNYSLOPE, 1350 SUNNYSLOPE ROAD,

BROOKFIELD, WI 530051

11/01/2019 10/31/2021FROEDTERT PHYSICIANS PARTNERS, 110 LONE OAK LANE, HARTFORD, WI 530271

11/01/2019 10/31/2021FROEDERT PHYSICIANS PARTNERS, W168 N11237 WESTERN AVENUE, GERMANTOWN, WI 530222

11/01/2019 10/31/2021FROEDTERT COMMUNITY PHYSICIANS LINCOLN AVE HEALTH, 11211 W LINCOLN AVE, WEST ALLIS, WI 53227

2

11/01/2019 10/31/2021FROEDTERT COMMUNITY PHYSICIANS MOORLAND RESERVE, 4805 S. MOORLAND RD, NEW BERLIN, WI 53151

2

11/01/2019 10/31/2021FROEDTERT COMMUNITY PHYSICIANS SARGEANT CLINIC, 840 N 87TH ST, MILWAUKEE, WI 532262

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Mental Health Program Directory By County, City, and Provider Name

MUSKEGO

3162AURORA PSYCHIATRIC HOSPITAL MUSKEGO PROGRAMS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202012/14/2016

(414) 422-2190

(414) [email protected] SURFUS-LEWISTON

County: WaukeshaMUSKEGO, WI 53150S74W16775 JANESVILLE ROAD

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

OCONOMOWOC

1810ROGERS MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201908/01/1988

(262) 303-4337

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 5306634700 VALLEY ROAD

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

3099ROGERS MEMORIAL HOSPITAL - SILVER LAKE OUTPATIENT CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201809/28/2015

(262) 646-1049

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 530661205 CORPORATE CENTER DRIVE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 11/01/2018 10/31/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 11/01/2018 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 11/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 11/01/2018 10/31/2020

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 11/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 DHS 40.11(2)(B) 11/01/2018 10/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 2 W/TELEHEALTH DHS 40.11(2)(B)

11/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3254ROGERS MEMORIAL HOSPITAL, INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202006/18/201906/18/2019

(262) 567-3490

(262) [email protected] SCHULTZ

County: WaukeshaOCONOMOWOC, WI 530661230 CORPORATE CENTER DR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/18/2019 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 06/18/2019 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 06/18/2019 10/31/2020

MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 06/18/2019 11/29/2019

Services

NO BRANCH LOCATIONS

1841SOUTH STREET CLINIC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/1984

(262) 567-3097

(262) [email protected] A WESTON, PHD

County: WaukeshaOCONOMOWOC, WI 53066169 E WISCONSIN AVE STE G

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

WAUKESHA

1001A HEALING CENTER/EFFICIENCY MANAGEMENT CONSULTING, S.C.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202009/01/1987

(262) 821-6119

(262) [email protected] P.

County: WaukeshaWAUKESHA, WI 5318620860 WATERTOWN ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

2386AURORA BEHAVIORAL HEALTH CENTER - WAUKESHA

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/2002

(414) 454-6450

(414) [email protected] VALENTIN

County: WaukeshaWAUKESHA, WI 53186W231 N1440 CORPORATE CT #310

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2018 04/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2018 04/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-MENOMONEE FALLS, W84W16889 MENOMONEE AVE,

MENOMONEE FALLS, WI 530511

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-BROOKFIELD, 16985 WEST BLUEMOUND ROAD, BROOKFIELD, WI 53005

2

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, 14555 W NATIONAL AVE, NEW BERLIN, WI 53151

2

05/01/2018 04/30/2020AURORA BEHAVIORAL HEALTH CENTER-SUMMIT, 36500 AURORA DRIVE, SUMMIT, WI 530662

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Mental Health Program Directory By County, City, and Provider Name

3022BETHANY CHRISTIAN SERVICES OF WI

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202006/01/201806/01/2014

(262) 547-3644

(262) [email protected] SCHMEICHEL

County: WaukeshaWAUKESHA, WI 53188N14W23755 STONE RIDGE DR #265

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2018 05/31/2020

Services

NO BRANCH LOCATIONS

1134CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC.

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201906/01/1981

(262) 547-8002

(262) [email protected] BIBO

County: WaukeshaWAUKESHA, WI 53186717 N EAST AVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

Services

NO BRANCH LOCATIONS

1340FAMILY SERVICE OF WAUKESHA

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202202/01/202009/01/1977

(262) 547-1608

(262) [email protected] CHERONE

County: WaukeshaWAUKESHA, WI 53186101 W BROADWAY, 2ND FLOOR

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 02/01/2020 01/31/2022

Services

Branch Begin/End DatesBranch Location(s)Tier02/01/2020 01/31/2022FAMILY SERVICE OF WAUKESHA, 175 EAST WISCONSIN AVE STE H, OCONOMOWOC, WI 530662

02/01/2020 01/31/2022FAMILY SERVICE OF WAUKESHA, 726 N EAST AVENUE, WAUKESHA, WI 531862

Setting Begin/End DatesNon-Certified School Setting(s)02/01/2020 01/31/2022ARROWHEAD UNION HIGH SCHOOL - NORTH, 800 NORTH AVE, HARTLAND, WI 53029

02/01/2020 01/31/2022ARROWHEAD UNION HIGH SCHOOL - SOUTH, 700 NORTH AVE, HARTLAND, WI 53029

02/01/2020 01/31/2022BANTING ELEMENTARY SCHOOL, 2019 BUTLER DR, WAUKESHA, WI 53186

02/01/2020 01/31/2022BLAIR ELEMENTARY SCHOOL, 301 HYDE PARK AVE, WAUKESHA, WI 53186

02/01/2020 01/31/2022DOUSMAN ELEMENTARY SCHOOL, 341 E OTTAWA AVE, DOUSMAN, WI 53118

02/01/2020 01/31/2022GREENLAND ELEMENTARY SCHOOL, 440 E COOLIDGE ST, OCONOMOWOC, WI 53066

02/01/2020 01/31/2022HADFIELD ELEMENTARY SCHOOL, 733 LINDEN ST, WAUKESHA, WI 53186

02/01/2020 01/31/2022HORNING MIDDLE SCHOOL, 2000 WOLF RD, WAUKESHA, WI 53189

02/01/2020 01/31/2022IXONIA ELEMENTARY SCHOOL, N8425 NORTH STREET, IXONIA, WI 53036

02/01/2020 01/31/2022MADISON ELEMENTARY SCHOOL, 9925 W GLENDALE, WAUWATOSA, WI 53225

02/01/2020 01/31/2022MEADOW VIEW ELEMENTARY SCHOOL, W360 N7077 BROWN ST, OCONOMOWOC, WI 53066

02/01/2020 01/31/2022NATURE HILL INTERMEDIATE SCHOOL, 850 LAKE DRIVE, OCONOMOWOC, WI 53066

02/01/2020 01/31/2022PARK LAWN ELEMENTARY SCHOOL, 300 PARKLAWN ST, OCONOMOWOC, WI 53066

02/01/2020 01/31/2022SOUTH HIGH SCHOOL, 222 MAPLE AVE, WAUKESHA, WI 53186

02/01/2020 01/31/2022SUMMIT ELEMENTARY SCHOOL, 1680 VALLEY ROAD, OCONOMOWOC, WI 53066

02/01/2020 01/31/2022WALES ELEMENTARY SCHOOL, 219 N OAK CREST DR, WALES, WI 53183

02/01/2020 01/31/2022WHITTIER ELEMENTARY SCHOOL, 1103 S EAST AVENUE, WAUKESHA, WI 53186

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Mental Health Program Directory By County, City, and Provider Name

3107HOPE FOR A BETTER TOMORROW

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201812/01/2015

(262) 910-1653

(262) [email protected]. SHEILA GISSIBL

County: WaukeshaWAUKESHA, WI 531882607 N GRANDVIEW BLVD, #110

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

NO BRANCH LOCATIONS

1974PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202006/01/1986

(262) 928-5096

(262) [email protected] GRZYBOWSKI

County: WaukeshaWAUKESHA, WI 53188721 AMERICAN AVENUE #501

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 01/01/2020 12/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - DELAFIELD, 2750 GOLF ROAD, DELAFIELD, WI 530181

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - WATERTOWN, 109 AIR PARK DR, WATERTOWN, WI 530941

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - BIG BEND RD, 2130 BIG BEND ROAD, WAUKESHA, WI 53189

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - HARTLAND, 1500 WALNUT RIDGE DR, HARTLAND, WI 53029

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - MORELAND BLVD., 717 WEST MORELAND BLVD, WAUKESHA, WI 53188

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - MUKWONAGO, 240 WEST MAPLE AVE, MUKWONAGO, WI 53149

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - MUSKEGO, S69 W15636 JANESVILLE RD, MUSKEGO, WI 53150

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - NEW BERLIN, 13900 WEST NATIONAL AVE, NEW BERLIN, WI 53151

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - OCONOMOWOC, 1185 CORPORATE CENTER DR SUITE 175 - 320, OCONOMOWOC, WI 53066

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - PEWAUKEE, N16W24131 RIVERWOOD DR., WAUKESHA, WI 53188

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS - SUSSEX, N57 W24950 N CORPORATE CIRCLE, SUSSEX, WI 53089

2

01/01/2020 12/31/2021PHCMA, INC. BEHAVIORAL HEALTH SVS- BARSTOW ST, 210 NW BARSTOW ST, WAUKESHA, WI 53188

2

01/01/2020 12/31/2021PHCMA, INC.BEHAVIORAL HLTH SVS - BROOKFIELD, 195 DISCOVERY DR, BROOKFIELD, WI 530452

01/23/2020 12/31/2021ST JOHNS NW MILITARY ACADEMY, 1101 GENESEE ST, DELAFIELD, WI 530183

3221STRESS MANAGEMENT & MENTAL HEALTH CLINICS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/2018

(262) 544-6377

(262) [email protected] WEAVER

County: WaukeshaWAUKESHA, WI 531882717 N GRANDVIEW BLVD #303

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

3042WAUKESHA COUNTY DHHS CCS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/01/2014

(262) 896-8180

(262) [email protected] BIRDEAU

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL POPULATION-BASED DHS 36 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020WAUKESHA CO DHHS HUMAN SERVICES CENTER, 514 RIVERVIEW AVE, WAUKESHA, WI 531881

1972WAUKESHA COUNTY HEALTH AND HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/1990

(262) 896-8046

(262) [email protected] HAAS

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

1971WAUKESHA COUNTY MENTAL HEALTH CENTER

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202005/01/201804/01/1987

(262) 896-8046

(262) [email protected] LEWIS

County: WaukeshaWAUKESHA, WI 531881501 AIRPORT ROAD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 05/01/2018 04/30/2020

MENTAL HEALTH-INPATIENT DHS 61.71 05/01/2018 04/30/2020

Services

NO BRANCH LOCATIONS

1970WAUKESHA COUNTY, DBA WAUKESHA COUNTY DHHS

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 04/30/202105/01/201904/01/1984

(262) 548-7656

(262) [email protected] SEYMOUR

County: WaukeshaWAUKESHA, WI 53188514 RIVERVIEW AVENUE

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 05/01/2019 04/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 05/01/2019 04/30/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 05/01/2019 04/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier05/01/2019 04/30/2021WAUKESHA COUNTY MENTAL HEALTH CENTER, 1501 AIRPORT RD, WAUKESHA, WI 531882

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Mental Health Program Directory By County, City, and Provider Name

1976WAUKESHA MEMORIAL HOSPITAL

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201906/01/1986

(262) 928-5382

(262) [email protected] GRZYBOWSKI

County: WaukeshaWAUKESHA, WI 53188725 AMERICAN AVENUE

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 01/01/2019 12/31/2020

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 01/01/2019 12/31/2020

CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 01/01/2019 12/31/2020

MENTAL HEALTH-DAY TREATMENT DHS 61.75 01/01/2019 12/31/2020

MENTAL HEALTH-INPATIENT DHS 61.71 01/01/2019 12/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WAUPACANEW LONDON

2750RAWHIDE YOUTH & FAMILY COUNSELING SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201908/23/2007

(920) 531-2662

(920) [email protected] ANN SMITH

County: WaupacaNEW LONDON, WI 54961E7475 RAWHIDE ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021RAWHIDE YOUTH & FAMILY SVS, 5460 N 64TH ST, MILWAUKEE, WI 532181

09/01/2019 08/31/2021RAWHIDE YOUTH & FAMILY SVS, 916 WILLARD DR STE 100, GREEN BAY, WI 543031

09/01/2019 08/31/2021RAWHIDE YOUTH & FAMILY SVS, W 3950 WI-23 TRUNCK, FOND DU LAC, WI 549371

09/01/2019 08/31/2021RAWHIDE - SHIOCTON, N5367 MAYFLOWER ROAD, SHIOCTON, WI 541702

09/01/2019 08/31/2021RAWHIDE YOUTH & FAMILY COUNSELING SVS, 446 WESTHILL BLVD STE 6, APPLETON, WI 549142

09/01/2019 08/31/2021RAWHIDE YOUTH & FAMILY COUNSELING SVS, 5555 N PORT WASHINGTON RD STE 207, GLENDALE, WI 53217

2

Setting Begin/End DatesNon-Certified School Setting(s)09/01/2019 08/31/2021MILWAUKEE ACADEMY OF SCIENCE, 2000 W KILBOURN, MILWAUKEE, WI 53233

09/01/2019 08/31/2021NEW LONDON HIGH SCHOOL, 1700 KLATT ROAD, NEW LONDON, WI 54961

09/01/2019 08/31/2021NEW LONDON MIDDLE SCHOOL, 1000 W WASHINGTON ST, NEW LONDON, WI 54961

WAUPACA

2123WAUPACA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201812/01/1981

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

3109WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202003/01/2016

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING ST

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 01/01/2020 12/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

1977WAUPACA COUNTY DEPT OF HEALTH AND HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202107/01/201912/01/1981

(715) 258-6409

(715) [email protected] NICHOLS

County: WaupacaWAUPACA, WI 54981811 HARDING STREET

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2019 06/30/2021

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2019 06/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2019 06/30/2021

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2019 06/30/2021

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2019 06/30/2021WAUPACA CO DEPT OF HEALTH & HUMAN SERV, 1405 MILL ST, NEW LONDON, WI 549611

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Mental Health Program Directory By County, City, and Provider Name

WAUSHARAWAUTOMA

3191FAMILY HEALTH LA CLINICA

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/05/2018

(920) 787-4737

(920) [email protected] AMBROSIUS

County: WausharaWAUTOMA, WI 54982400 SOUTH TOWNLINE ROAD

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

NO BRANCH LOCATIONS

1980WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/01/1975

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 04/12/2019 11/29/2019

CSAS-PREVENTION DHS 75.04 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 04/12/2019 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2018 10/31/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 04/12/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020BERLIN HIGH SCHOOL, 222 MEMORIAL DRIVE, BERLIN, WI 549233

11/01/2018 10/31/2020TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 549663

11/01/2018 10/31/2020WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI 549823

11/01/2018 10/31/2020WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI 539643

11/01/2018 10/31/2020WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI 549843

1979WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201808/01/1997

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2018 10/31/2020

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM W/TELEHEALTH DHS 63 07/15/2019

11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2618WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/19/2005

(920) 787-0421

(920) [email protected] MORGAN-JONES

County: WausharaWAUTOMA, WI 54982230 W PARK STREET

CCS Affiliaton: 01/01/2016Begin: End: Lead:Central Wisconsin Health Partnership V2

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 11/01/2018 10/31/2020

CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 36 07/15/2019 11/29/2019

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WINNEBAGOMENASHA

1138CATHOLIC CHARITIES DIOCESE OF GREEN BAY, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202012/01/201801/26/1988

(920) 437-4067

(920) [email protected] J GARDNER

County: WinnebagoMENASHA, WI 549521475 OPPORTUNITY WAY

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 01/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 01/31/2020CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 36 BROAD ST, #200, OSHKOSH, WI 549011

12/01/2018 01/31/2020CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 364 S CAMBRIDGE STREET, WAUTOMA, WI 54982

1

12/01/2018 01/31/2020CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, N2845 SHADOW RD, WAUPACA, WI 549811

3209ONE LOVE - HARMONIZING MIND, BODY & SPIRIT

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 05/31/202106/01/201906/01/2018

() -

(920) [email protected] HOFACKER

County: WinnebagoMENASHA, WI 549521366 APPLETON ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 06/01/2019 05/31/2021

Services

NO BRANCH LOCATIONS

1333THE COUNSELING CLINIC-FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202012/01/201803/01/1983

(920) 739-7639

(920) [email protected] RAPPEL

County: WinnebagoMENASHA, WI 549521810 APPLETON ROAD

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2018 11/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier12/01/2018 11/30/2020PARKVIEW LEARNING CENTER, 217 E KIMBERLY AVE, KIMBERLY, WI 541362

12/01/2018 11/30/2020JANSSEN ELEMENTARY SCHOOL, 420 WALLACE ST, COMBINED LOCKS, WI 541133

12/01/2018 11/30/2020JR GERRITS MIDDLE SCHOOL, 545 SOUTH JOHN ST, KIMBERLY, WI 541363

12/01/2018 11/30/2020KAUKAUNA HIGH SCHOOL, 1701 COUNTY ROAD CE, KAUKAUNA, WI 541303

12/01/2018 11/30/2020KIMBERLY HIGH SCHOOL, 1662 E KENNEDY AVE, KIMBERLY, WI 541363

12/01/2018 11/30/2020LITTLE CHUTE HIGH SCHOOL, 1402 FREEDOM ROAD, LITTLE CHUTE, WI 541403

12/01/2018 11/30/2020LITTLE CHUTE MIDDLE SCHOOL, 325 MEULMANS STREET, LITTLE CHUTE, WI 541403

12/01/2018 11/30/2020MAPLEVIEW INTERMEDIATE SCHOOL, 125 E KIMBERLY AVE, KIMBERLY, WI 541363

12/01/2018 11/30/2020NEENAH HIGH SCHOOL, 1275 TULLAR RD, NEENAH, WI 549563

12/01/2018 11/30/2020SHATTUCK MIDDLE SCHOOL, 600 ELM STREET, NEENAH, WI 549563

12/01/2018 11/30/2020SUNRISE ELEMENTARY SCHOOL, N9363 EXPLORATION DR, APPLETON, WI 549153

12/01/2018 11/30/2020WESTSIDE ELEMENTARY SCHOOL, 746 W 3RD ST, KIMBERLY, WI 541363

12/01/2018 11/30/2020WOODLAND ELEMENTARY SCHOOL, N9085 N COOP RD, APPLETON, WI 549153

12/01/2018 11/30/2020WOODLAND INTERMEDIATE SCHOOL, N9085 N COOP RD, APPLETON, WI 549153

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Mental Health Program Directory By County, City, and Provider Name

1355THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 02/28/202103/01/201903/01/1983

(920) 886-9357

(920) [email protected] EICHORST

County: WinnebagoMENASHA, WI 549521478 KENWOOD DRIVE SUITE 1

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 03/01/2019 02/28/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 03/01/2019 02/28/2021

Services

Branch Begin/End DatesBranch Location(s)Tier03/01/2019 02/28/2021THE SAMARITAN COUNSELING CTR FOX VALLEY, 510 SULLIVAN AVENUE, KAUKAUNA, WI 541301

03/01/2019 02/28/2021THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI 549012

03/01/2019 02/28/2021THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI 549612

2052THEDACARE BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201807/31/1998

(920) 720-3719

(920) [email protected] MEYER

County: WinnebagoMENASHA, WI 549521095 MIDWAY ROAD

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/2018 06/30/2020

Services

Branch Begin/End DatesBranch Location(s)Tier07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI 549611

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI 541662

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 2500 E CAPITAL DRIVE, APPLETON, WI 549112

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 333 GREEN BAY RD, NEENAH, WI 549562

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI 549012

07/01/2018 06/30/2020THEDACARE BEHAVIORAL HEALTH, 902 RIVERSIDE DRIVE, #204, WAUPACA, WI 549812

NEENAH

1830REACH COUNSELING SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/11/1993

(920) 722-0142

(920) [email protected] BEYER

County: WinnebagoNEENAH, WI 549561509 S COMMERCIAL STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020REACH COUNSELING SERVICES, INC., 414 DOCTORS COURT, SUITE 110, OSHKOSH, WI 549011

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Mental Health Program Directory By County, City, and Provider Name

1946THEDACARE REGIONAL MEDICAL CENTER NEENAH - BEHAVIORAL HEALTH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201903/01/1983

(920) 729-2906

(920) [email protected] BUTTS

County: WinnebagoNEENAH, WI 54956130 SECOND STREET

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 02/01/2019 01/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

2006WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201807/01/1988

(920) 720-9682

(920) [email protected] SOROKO

County: WinnebagoNEENAH, WI 54956211 N COMMERCIAL STREET

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

2278WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201811/01/2000

(920) 720-9682

(920) [email protected] AMOS

County: WinnebagoNEENAH, WI 54956211 N COMMERCIAL STREET

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

OSHKOSH

3218ASCENSION NE WISCONSIN - MERCY CAMPUS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201906/01/2018

(920) 223-3404

(920) [email protected] MEENK

County: WinnebagoOSHKOSH, WI 54904500 S OAKWOOD RD

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/2019 08/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

3219ASCENSION NE WISCONSIN - MERCY CAMPUS

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201906/01/2018

(920) 223-3404

(920) [email protected] MEENK

County: WinnebagoOSHKOSH, WI 549042700 W 9TH AVENUE STE 102

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2540AURORA MEDICAL GROUP OSHKOSH

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 08/31/202109/01/201909/01/2004

(920) 456-2025

(920) [email protected] WASSMANN

County: WinnebagoOSHKOSH, WI 54904700 N WESTHAVEN DRIVE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/01/2019 08/31/2021

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 09/01/2019 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier09/01/2019 08/31/2021AURORA MEDICAL GROUP NORTH FOND DU LAC, 700 N PARKRIDGE LN, NORTH FOND DU LAC, WI

549372

09/01/2019 08/31/2021AURORA MEDICAL GROUP OSHKOSH, 1136 WESTOWNE DR, NEENAH, WI 549562

09/01/2019 08/31/2021AURORA MEDICAL GROUP OSHKOSH, 1242 W FOND DU LAC STREET, RIPON, WI 549712

09/01/2019 08/31/2021AURORA MEDICAL GROUP OSHKOSH, 210 WISCONSIN AMERICAN DRIVE, FOND DU LAC, WI 549352

09/01/2019 08/31/2021AURORA MEDICAL GROUP OSHKOSH, 414 DOCTORS CT, OSHKOSH, WI 549012

09/01/2019 08/31/2021AURORA MEDICAL GROUP OSHKOSH, 855 N WESTHAVEN DR, OSHKOSH, WI 549042

1723OSHKOSH COUNSELING CENTER, INC.

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 11/30/202112/01/201909/01/1985

(920) 231-4048

(920) [email protected] NIEMUTH

County: WinnebagoOSHKOSH, WI 54901501 MERRITT AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 12/01/2019 11/30/2021

Services

NO BRANCH LOCATIONS

2007WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/01/1975

(920) 236-1157

(920) [email protected] SOROKO

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

Service Begin/End DatesAdm Code

CSAS-EMERGENCY OUTPATIENT DHS 75.05 11/01/2018 10/31/2020

CSAS-OUTPATIENT TREATMENT DHS 75.13 11/01/2018 10/31/2020

CSAS-PREVENTION DHS 75.04 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

2266WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201810/01/1975

(920) 236-1157

(920) [email protected] HOODIE

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63 11/01/2018 10/31/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2579WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/09/2005

(920) 236-1157

(920) [email protected] SOROKO

County: WinnebagoOSHKOSH, WI 54903220 WASHINGTON AVENUE

CCS Affiliaton: 09/01/2014Begin: End: Lead:Northeastern Region CCS Consortium

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 04/01/2019 03/31/2021

Services

NO BRANCH LOCATIONS

ROSCOE

3182HOPE - CHILD AND FAMILY COUNSELING INC

Surveyor: Anastasia E. Vega

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 07/31/202008/01/201808/22/2017

(866) 303-8062

(815) [email protected] WAGNER

County: WinnebagoROSCOE, IL 6107311447 2ND ST SUITE 9B

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 08/01/2018 07/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier08/01/2018 07/31/2020HOPE - CHILD AND FAMILY COUNSELING INC, 20 ECLIPSE CENTER, BELOIT, WI 535112

Setting Begin/End DatesNon-Certified School Setting(s)08/01/2018 07/31/2020FRUZEN INTERMEDIATE, 2600 MILWAUEE RD, BELOIT, WI 53511

08/01/2018 07/31/2020MCNEAL, 1524 FREDERICK ST, BELOIT, WI 53511

08/01/2018 07/31/2020TODD ELEMENTARY, 1621 OAKWOOD AVE, BELOIT, WI 53511

WINNEBAGO

2008WINNEBAGO MENTAL HEALTH INSTITUTE

Surveyor: Heather Schweiner

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202111/01/201910/01/1975

(920) 237-2043

(920) 237-2802 [email protected] LUNDQUIST

County: WinnebagoWINNEBAGO, WI 54985TREFFERT DRIVE & BUTLER AVENUE

Service Begin/End DatesAdm Code

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

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

WOODMARSHFIELD

2623MARRIAGE AND FAMILY HEALTH SERVICES, LTD.

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202001/01/201901/01/2006

(715) 832-0771

(715) [email protected] MICHALEK

County: WoodMARSHFIELD, WI 54449501 SOUTH CHERRY AVE, #5

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2019 12/31/2020

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 01/01/2019 12/31/2020

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2019 12/31/2020EAST JUNIOR HIGH SCHOOL, 311 LINCOLN STREET, WISCONSIN RAPIDS, WI 544943

01/01/2019 12/31/2020GRANT ELEMENTARY, 425 W UPHAM ST, MARSHFIELD, WI 544493

01/01/2019 12/31/2020LINCOLN ELEMENTARY, 1621 S FELKER AVE, MARSHFIELD, WI 544493

01/01/2019 12/31/2020LINCOLN HIGH SCHOOL, 1801 16TH STREET SOUTH, WISCONSIN RAPIDS, WI 544943

01/01/2019 12/31/2020MADISON ELEMENTARY, 510 N PALMETTO AVE, MARSHFIELD, WI 544493

01/01/2019 12/31/2020MARSHFIELD HIGH SCHOOL, 1401 E BECKER ROAD, MARSHFIELD, WI 544493

01/01/2019 12/31/2020MARSHFIELD MIDDLE SCHOOL, 900 EAST 4TH STREET, MARSHFIELD, WI 544493

01/01/2019 12/31/2020NASONVILLE ELEMENTARY, 11044 US HIGHWAY 10, MARSHFIELD, WI 544493

01/01/2019 12/31/2020WASHINGTON ELEMENTARY, 1112 W 11TH ST, MARSHFIELD, WI 544493

1566MARSHFIELD MEDICAL CENTER CLINIC PROF SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 10/31/202011/01/201812/01/1982

(715) 387-9025

(715) [email protected] BUMP

County: WoodMARSHFIELD, WI 544491000 N OAK AVENUE

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 11/01/2018 10/31/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 11/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier11/01/2018 10/31/2020MARSHFIELD CLINIC-CHIPPEWA FALLS, 2655 CO HWY I, CHIPPEWA FALLS, WI 547291

11/01/2018 10/31/2020MARSHFIELD CLINIC-HAYWARD, 10212 N GREENWOOD LN, HAYWARD, WI 548431

11/01/2018 10/31/2020MARSHFIELD CLINIC-LADYSMITH, 906 COLLEGE AVE, LADYSMITH, WI 548481

11/01/2018 10/31/2020MARSHFIELD CLINIC-MENOMONIE, 3603 SCHNEIDER AVE, MENOMONIE, WI 547511

11/01/2018 10/31/2020MARSHFIELD CLINIC-MOSINEE CENTER, 390 ORBITING DR, MOSINEE, WI 544551

11/01/2018 10/31/2020MARSHFIELD CLINIC-WAUSAU CENTER, 2727 PLAZA DR, WAUSAU, WI 544011

11/01/2018 10/31/2020MARSHFIELD CLINIC-WI RAPIDS CENTER, 220 24TH ST, WISCONSIN RAPIDS, WI 544941

11/01/2018 10/31/2020MARSHFIELD CLINIC-LAKE HALLIE, 12961 27TH AVE, CHIPPEWA FALLS, WI 547292

11/01/2018 10/31/2020MARSHFIELD CLINIC-LAKEWOODS, 1215 W KNAPP, RICE LAKE, WI 548682

11/01/2018 10/31/2020MARSHFIELD CLINIC-MINOCQUA CENTER, 9601 TOWNLINE RD, MINOCQUA, WI 545482

11/01/2018 10/31/2020MARSHFIELD CLINIC-PARK FALLS CENTER, 50 SHERRY AVE, PARK FALLS, WI 545522

11/01/2018 10/31/2020MARSHFIELD CLINIC-RIVERVIEW, 1000 STARR AVE, EAU CLAIRE, WI 547012

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Mental Health Program Directory By County, City, and Provider Name

1709NORWOOD HEALTH CENTER

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 01/31/202102/01/201904/01/1980

(715) 387-1533

(715) [email protected] BRUCE

County: WoodMARSHFIELD, WI 544491600 N CHESTNUT AVE

Service Begin/End DatesAdm Code

CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 02/01/2019 01/31/2021

MENTAL HEALTH-INPATIENT DHS 61.71 02/01/2019 01/31/2021

Services

NO BRANCH LOCATIONS

3019WISE MIND MENTAL HEALTH CLINIC, LLC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201903/31/2014

(715) 384-0090

(715) [email protected] K FABER

County: WoodMARSHFIELD, WI 54449601 EAST 3RD ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 04/01/2019 03/31/2021

Services

Setting Begin/End DatesNon-Certified School Setting(s)09/16/2019 03/31/2021MARSHFIELD HIGH SCHOOL, 1401 E BECKER ROAD, MARSHFIELD, WI 54449

WISCONSIN RAPIDS

3231ASPIRUS RIVERVIEW BEHAVIORAL HEALTH CLINIC

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202010/01/201810/01/2018

(715) 422-9320

(715) [email protected] HARRIS

County: WoodWISCONSIN RAPIDS, WI 54494420 DEWEY ST

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2018 09/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 10/01/2018 11/29/2019

Services

NO BRANCH LOCATIONS

2293CENTRAL WISCONSIN COUNSELING ASSOCIATES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 12/31/202101/01/202001/01/2001

(715) 424-6963

(715) [email protected] GUNDERSON

County: WoodWISCONSIN RAPIDS, WI 54495320 W. GRAND AVE SUITE 304A

Service Begin/End DatesAdm Code

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 01/01/2020 12/31/2021

Services

Branch Begin/End DatesBranch Location(s)Tier01/01/2020 12/31/2021LINCOLN HIGH SCHOOL, 1801 - 16TH STREET SOUTH, WISCONSIN RAPIDS, WI 544943

01/01/2020 12/31/2021RIVER CITIES HIGH SCHOOL, 2390 - 48TH STREET SOUTH, WISCONSIN RAPIDS, WI 544953

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Mental Health Program Directory By County, City, and Provider Name

1208CLINICAL SERVICES

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202110/01/201910/01/1988

(715) 424-3441

(715) [email protected] MICHAEL J NELSON

County: WoodWISCONSIN RAPIDS, WI 54495420 3RD STREET SOUTH

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 10/01/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 10/01/2019 09/30/2021

Services

NO BRANCH LOCATIONS

3268CLINICAL SERVICES

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 09/30/202109/18/201909/18/2019

(715) 712-1341

(715) [email protected] SIGLER EDMUNDSON

County: WoodWISCONSIN RAPIDS, WI 54494420 3RD STREET SO

Service Begin/End DatesAdm Code

CSAS-OUTPATIENT TREATMENT DHS 75.13 09/18/2019 09/30/2021

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 09/18/2019 09/30/2021

Services

NO BRANCH LOCATIONS

2291NORTHWEST COUNSELING & GUIDANCE CLINIC DBA NORTHWEST JOURNEY - WISCONSIN RAPIDS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 03/31/202104/01/201902/12/2001

(855) 897-2741

(715) [email protected] MAURER

County: WoodWISCONSIN RAPIDS, WI 54494110 24TH ST S

Service Begin/End DatesAdm Code

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)(A) 04/01/2019 03/31/2021

MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 W/TELEHEALTH DHS 40.11(2)(A)

04/01/2019 11/29/2019

Services

NO BRANCH LOCATIONS

2678WOOD COUNTY HUMAN SERVICES CCS

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201808/01/1977

(715) 421-2266

(715) [email protected] SCHEIDEGGER

County: WoodWISCONSIN RAPIDS, WI 54494111 W JACKSON ST

CCS Affiliaton: 09/01/2014Begin: End: Lead:Portage Wood Partnership

Service Begin/End DatesAdm Code

CCS REGIONAL MODEL SHARED SERVICES DHS 36 07/01/2018 06/30/2020

Services

NO BRANCH LOCATIONS

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Mental Health Program Directory By County, City, and Provider Name

2019WOOD COUNTY HUMAN SERVICES DEPARTMENT

Surveyor: Roderick Senn

Initial Cert:Cert Eff:Cert Exp:

Fax:

Phone: 06/30/202007/01/201808/01/1977

(715) 421-2266

(715) [email protected] SCHUELER SHEVELAND

County: WoodWISCONSIN RAPIDS, WI 54494111 W JACKSON ST

Service Begin/End DatesAdm Code

CSAS-DAY TREATMENT DHS 75.12 07/01/2018 06/30/2020

CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.12 07/01/2018 11/29/2019

CSAS-EMERGENCY OUTPATIENT DHS 75.05 07/01/2018 06/30/2020

CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 07/01/2018 11/29/2019

CSAS-OUTPATIENT TREATMENT DHS 75.13 07/01/2018 06/30/2020

CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.13 07/01/2018 11/29/2019

MENTAL HEALTH OUTPATIENT CLINIC DHS 35 07/01/2018 06/30/2020

MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35 07/01/2018 11/29/2019

MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3 07/01/2018 06/30/2020

MENTAL HEALTH-EMERGENCY SERVICE 3 W/TELEHEALTH DHS 34.3 07/01/2018 11/29/2019

Services

Branch Begin/End DatesBranch Location(s)Tier10/25/2019 06/30/2020CORNERSTONE, 630 S CENTRAL AVE SUITE 204, MARSHFIELD, WI 544492

07/01/2018 06/30/2020NORWOOD HEALTH CARE BRANCH OFFICE, 1600 NORTH CHESTNUT, MARSHFIELD, WI 544492

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