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 128 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1406 HEARTLAND CLINIC YVONNE ZUBATY 406 ELM STREET BOSCOBEL, WI 53805 County: Grant heartlandclinic@mhtc.net Phone: (608) 375-2700 Fax: (608) 375-2146 Surveyor: Cynthia Lindgren Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 12/01/1989 12/01/2007 11/30/2009 Mental Health-Outpatient DHS 61.91 2669 HERGERT & ASSOCIATES FAMILY COUNSELING SERVICES LISA HERGERT 252 S CENTRAL AVENUE, #21 MARSHFIELD, WI 54449 County: Wood lrherge@aol.com Phone: (715) 384-7579 Fax: (715) 384-8131 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 NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 05/08/2006 01/01/2011 12/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1409 HESS MEMORIAL HOSPITAL, INC., DBA MILE BLUFF MEDICAL CENTER JIM O'KEEFE 1050 DIVISION STREET MAUSTON, WI 53948 County: Juneau mfry@milebluff.com Phone: (608) 847-6161 Fax: (608) 847-1843 Surveyor: William Rohner Services HERGERT & ASSOCIATES FAMILY COUNSELING 2900 HOOVER AVENUE, #B STEVENS POINT, WI 54481 12/01/2007 11/30/2009 Tier 1 01/01/2011 12/31/2012 Administrative Code Chapter Service Begin/End Dates 06/01/1987 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 01/01/2011 12/31/2012 01/01/2011 12/31/2012 ELROY FAMILY MEDICAL CENTER Tier 1 1515 ACADEMY 05/01/2011 ELROY, WI 53929 04/30/2013 LAKE DELTON CLINIC Tier 1 28 COMMERCE STREET 05/01/2011 LAKE DELTON, WI 53940 04/30/2013 NECEDAH FAMILY MEDICAL CENTER Tier 1 1408 WHEELIHAN AVE 05/01/2011 NECEDAH, WI 54646 04/30/2013 Administrative Code Chapter Service Begin/End Dates 05/01/2011 04/30/2013 05/01/2011 04/30/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 129 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2823 HIAWATHA VALLEY MENTAL HEALTH CENTER JULIE HANSON 166 MAIN STREET WINONA, MN 55987 County/State: Winona, MN julieh@hvmhc.org Phone: (507) 454-4341 Fax: (507) 453-6267 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 09/21/2009 09/01/2012 08/31/2014 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2937 HIAWATHA VALLEY MENTAL HEALTH CENTER JULIE HANSON 319 MAIN STREET LA CROSSE, WI 54601 County: La Crosse julieh@hvmhc.org Phone: (608) 796-1168 Fax: (608) 796-1944 Surveyor: Polly Wong Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates HIAWATHA VALLEY MENTAL HEALTH CENTER 319 MAIN STREET LA CROSSE, WI 54601 HIAWATHA VALLEY MENTAL HEALTH CENTER LA CROSSE CNTY JUVE FAC.- 300 4TH ST N LA CROSSE, WI 54601 HIAWATHA VALLEY MENTAL HEALTH CENTER 611 BROADWAY AVENUE, #100 WABASHA, MN 55981 Tier 2 09/01/2012 08/31/2014 Tier 2 09/01/2012 08/31/2014 Tier 2 09/01/2012 08/31/2014 Administrative Code Chapter Service Begin/End Dates 03/01/2011 03/01/2012 02/28/2013 CSAS-Intervention DHS 75.16 CSAS-Prevention DHS 75.04 2565 HIDDEN SPRINGS CLINIC DEAN JENSEN S 1597 HANSON ROAD WESTBY, WI 54667 County: Vernon hscdeanj@yahoo.com Phone: (608) 574-0582 Fax: (608) 634-6918 Surveyor: Cynthia Lindgren Services NO BRANCH LOCATIONS 09/01/2012 08/31/2014 09/01/2012 08/31/2014 Administrative Code Chapter Service Begin/End Dates 12/09/2004 07/01/2012 06/30/2014 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 03/01/2012 02/28/2013 03/01/2012 02/28/2013 Administrative Code Chapter Service Begin/End Dates 07/01/2012 06/30/2014
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