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 126 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1398 HAZELDEN MICHAEL ERB 15245 PLEASANT VALLEY ROAD CENTER CITY, MN 55012 County/State: Chisago, MN merb@hazelden.org Phone: (651) 213-4217 Fax: (651) 213-4344 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/1988 05/01/2011 04/30/2013 CSAS-Medically Monitored Residential Detox DHS 75.07 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Transitional Residential DHS 75.14 2916 HEALING HEARTS FAMILY COUNSELING CENTER, LLC PAT ANN ST. GERMAIN 1268 W MAIN STREET, #2 SUN PRAIRIE, WI 53590 County: Dane patann@healingheartscares.com Phone: (608) 333-5945 Fax: (608) 834-1132 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 NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 09/20/2010 10/01/2011 09/30/2013 Mental Health Outpatient Clinic DHS 35 1777 HEALTH CARE FOR THE HOMELESS OF MILWAUKEE, INC. CSP LIZ GABRIEL 711 W. CAPITOL DRIVE, #205 MILWAUKEE, WI 53206 County: Milwaukee lizg@orchc-milw.org Phone: (414) 374-2400 Fax: (414) 374-7917 Surveyor: Demetrius Anderson Services NO BRANCH LOCATIONS 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 07/17/1996 07/01/2011 06/30/2013 Mental Health-Community Support Program DHS 63 NO BRANCH LOCATIONS 10/01/2011 09/30/2013 Administrative Code Chapter Service Begin/End Dates 07/01/2011 06/30/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 127 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1402 HEALTH PSYCHOLOGY ASSOCIATES, SC GERALDINE BANKS 5800 N BAYSHORE DR #B230 GLENDALE, WI 53217 County: Milwaukee hpsych1@yahoo.com Phone: (414) 962-4072 Fax: (414) 962-4052 Surveyor: William Goehring Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/1991 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 2911 HEALTHY CONNECTIONS, LLC JESSICA SCHROEDER 821 E FIRST AVENUE STE 3 APPLETON, WI 54911 County: Outagamie healthyconnectionsllc@gmail.com Phone: (920) 257-4601 Fax: (920) 257-4603 Surveyor: Bradley Jahr Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates HEALTH PSYCHOLOGY ASSOCIATES Tier 2 5007 S HOWELL, #350 05/01/2011 MILWAUKEE, WI 53207 04/30/2013 Administrative Code Chapter Service Begin/End Dates 05/17/2010 06/01/2011 05/31/2013 Mental Health Outpatient Clinic DHS 35 2638 HEARTHSTONE THERAPY & CONSULTING, LLC DAWN KRUEGER 4810 S 76TH STREET SUITE 106 GREENFIELD, WI 53220 County: Milwaukee hearthstone2005@sbcglobal.net Phone: (414) 282-8353 Fax: (414) 282-8353 Surveyor: Demetrius Anderson Services NO BRANCH LOCATIONS 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 01/05/2006 01/01/2011 12/31/2012 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 06/01/2011 05/31/2013 Administrative Code Chapter Service Begin/End Dates 01/01/2011 12/31/2012
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Mental Health and Substance Abuse Programs in alphabetical

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