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Mental Health and Substance Abuse Programs in alphabetical

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DEPARTMENT OF HEALTH SERVICES<br />

Division of Quality Assurance<br />

Pr<strong>in</strong>t Date: 08/28/2012<br />

Page 118 of 335<br />

Certification Number/<br />

Certified Provider's Ma<strong>in</strong> Site/<br />

Email/Telephone<br />

1388<br />

GREEN COUNTY HUMAN SERVICES<br />

GREG HOLCOMB<br />

N3152 STATE ROAD 81<br />

MONROE, WI 53566<br />

County: Green<br />

gholcomb@gchsd.org<br />

Phone: (608) 328-9399<br />

Fax: (608) 328-9480<br />

Surveyor: William Rohner<br />

Services<br />

Community <strong>Substance</strong> <strong>Abuse</strong> <strong>and</strong> <strong>Mental</strong> <strong>Health</strong><br />

Program Certification Directory<br />

By Provider Name & Certification Number<br />

Initial Certification/<br />

Certification Effective/<br />

Certification Expires<br />

10/01/1975<br />

01/01/2012<br />

12/31/2013<br />

<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />

CSAS-Emergency Outpatient DHS 75.05<br />

CSAS-Outpatient Treatment DHS 75.13<br />

<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 DHS 34.3<br />

2265<br />

GREEN LAKE COUNTY DEPARTMENT OF HEALTH<br />

& HUMAN SERVICES CSP<br />

LINDA RICHARDS<br />

571 COUNTY ROAD A<br />

GREEN LAKE, WI 54941<br />

County: Green Lake<br />

glcdhhs@co.green-lake.wi.us<br />

Phone: (920) 294-4070<br />

Fax: (920) 294-4139<br />

Surveyor: William Goehr<strong>in</strong>g<br />

Services<br />

STATE OF WISCONSIN<br />

Bureau of <strong>Health</strong> Services<br />

PO Box 2969<br />

Madison, WI 53701-2969<br />

Tier/<br />

Branch Beg<strong>in</strong>/<br />

Branch Location(s) End Dates<br />

NO BRANCH LOCATIONS<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

11/01/2000<br />

11/01/2010<br />

10/31/2012<br />

<strong>Mental</strong> <strong>Health</strong>-Community Support Program DHS 63<br />

NO BRANCH LOCATIONS<br />

01/01/2012 12/31/2013<br />

01/01/2012 12/31/2013<br />

01/01/2012 12/31/2013<br />

01/01/2012 12/31/2013<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

11/01/2010 10/31/2012

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