Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
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 150 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2894<br />
KETTLE MORAINE COUNSELING SERVICES<br />
DEVONA MARSHALL<br />
125 N 6TH AVENUE, #201<br />
WEST BEND, WI 53095<br />
County: Wash<strong>in</strong>gton<br />
devona@kettlemora<strong>in</strong>ecounsel<strong>in</strong>g.com<br />
Phone: (262) 334-4340<br />
Fax: (262) 334-4341<br />
Surveyor: William Goehr<strong>in</strong>g<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 />
03/01/2010<br />
03/01/2011<br />
02/28/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
2288<br />
KEWAUNEE COUNTY DEPARTMENT OF HUMAN<br />
SERVICES CSP<br />
WILLIAM P KELSEY<br />
810 LINCOLN STREET<br />
KEWAUNEE, WI 54216<br />
County: Kewaunee<br />
seidlm@kewauneeco.org<br />
Phone: (920) 388-7030<br />
Fax: (920) 388-7044<br />
Surveyor: Frank Bellaire<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 />
KETTLE MORAINE COUNSELING Tier 2<br />
N62 W281 WASHINGTON AVENUE<br />
08/22/2011<br />
CEDARBURG, WI 53012<br />
02/28/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
02/01/1977<br />
02/01/2011<br />
01/31/2013<br />
<strong>Mental</strong> <strong>Health</strong>-Community Support Program DHS 63<br />
1466<br />
KEWAUNEE COUNTY DEPARTMENT OF HUMAN<br />
SERVICES<br />
MARK SEIDL<br />
810 LINCOLN<br />
KEWAUNEE, WI 54216<br />
County: Kewaunee<br />
seidlm@kewauneeco.org<br />
Phone: (920) 388-7030<br />
Fax: (920) 388-7044<br />
Surveyor: Frank Bellaire<br />
Services<br />
NO BRANCH LOCATIONS<br />
03/01/2011 02/28/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
02/01/1977<br />
02/01/2011<br />
01/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic with Telehealth DHS 35<br />
CSAS-Emergency Outpatent with Telehealth DHS 75.05<br />
CSAS-Emergency Outpatient DHS 75.05<br />
CSAS-Outpatient Treatment DHS 75.13<br />
CSAS-Outpatient Treatment with Telehealth DHS 75.13<br />
CSAS-Prevention DHS 75.04<br />
<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 DHS 34.3<br />
<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 w/Telehealth DHS 34.3<br />
NO BRANCH LOCATIONS<br />
02/01/2011 01/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013
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