Mental Health and Substance Abuse Programs in alphabetical

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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 100 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2903 FAMILY INNOVATIONS, INC CHERYL LERFALD 2115B COUNTY ROAD D, EAST MAPLEWOOD, MN 55109 County/State: Ramsey, MN clerflad@familyinnovations.com Phone: (651) 748-5019 Fax: (651) 773-7591 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/18/2010 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 2692 FAMILY OPTIONS COUNSELING, LLC KIMBERLY YOUNG 3015 N 114TH STREET WAUWATOSA, WI 53222 County: Milwaukee kyoung@familyoptions.com Phone: (414) 431-4444 Fax: (414) 431-0858 Surveyor: Demetrius Anderson Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates FAMILY INNOVATIONS, INC Tier 2 131 CARMICHAEL 05/01/2011 HUDSON, WI 54016 04/30/2013 Administrative Code Chapter Service Begin/End Dates 11/02/2006 11/01/2011 10/31/2013 Mental Health Outpatient Clinic DHS 35 1325 FAMILY RESOURCE CENTER LINDA DANIELS 533 PEACE PIPE ROAD LAC DU FLAMBEAU, WI 54538 County: Vilas ldaniels@pchclinic.com Phone: (715) 588-1511 Fax: (715) 588-3903 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 09/01/1988 09/01/2011 08/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 11/01/2011 10/31/2013 Administrative Code Chapter Service Begin/End Dates 09/01/2011 08/31/2013 09/01/2011 08/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 101 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1326 FAMILY RESOURCES ASSOCIATES, INC. JANICE SCHMIDT 1315 W. MAIN STREET WATERTOWN, WI 53094 County: Jefferson jschmidt@familyresourcesinc.com Phone: (920) 261-4100 Fax: (920) 261-8801 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 11/01/1993 11/01/2010 10/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2554 FAMILY SERVICE ASSOCIATES, SC DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SERVICES TOM HAYES 1002 LINCOLN AVENUE BARABOO, WI 53913 County: Sauk business@pauquette.ort Phone: (608) 356-9055 Fax: (608) 356-5457 Surveyor: William Rohner Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates FAMILY RESOURCES ASSOCIATES INC Tier 2 331 N MAIN STREET 11/01/2010 LAKE MILLS, WI 53551 10/31/2012 Administrative Code Chapter Service Begin/End Dates 08/01/2004 08/01/2011 07/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 Mental Health-Day Treatment for Children 1 DHS 40.11(2)(a) 1327 FAMILY SERVICE OF MADISON, INC. ANN LEWIS 128 E. OLIN AVENUE, #100 MADISON, WI 53713 County: Dane info@fsmad.org Phone: (608) 316-1129 Fax: (608) 252-1333 Surveyor: William Rohner Services FAMILY SERVICE ASSOCIATES SC DBA PAUQUETTE 710 N WEBB AVE REEDSBURG, WI 53959 FAMILY SERVICE ASSOCIATES SC DBA PAUQUETTE 50 PRAIRIE AVENUE PRAIRIE DU SAC, WI 53578 11/01/2010 10/31/2012 11/01/2010 10/31/2012 Tier 2 08/01/2011 07/31/2013 Tier 2 08/01/2011 07/31/2013 Administrative Code Chapter Service Begin/End Dates 04/01/1977 10/01/2011 09/30/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 CSAS-Prevention DHS 75.04 Mental Health-Day Treatment for Children 1 DHS 40.11(2)(a) NO BRANCH LOCATIONS 08/01/2011 07/31/2013 08/01/2011 07/31/2013 08/01/2011 07/31/2013 Administrative Code Chapter Service Begin/End Dates 10/01/2011 09/30/2013 10/01/2011 09/30/2013 10/01/2011 09/30/2013 10/01/2011 09/30/2013
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