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 158 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2890 LANGLADE HOSPITAL GENERAL CLINIC SYLVIA DENNISON MD 110 E FIFTH AVENUE ANTIGO, WI 54409 County: Langlade sylviad@aspirus.org Phone: (715) 623-2351 Fax: (715) 627-6124 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/27/2010 08/01/2011 07/31/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 2466 LARSON COUNSELING PAULA W LARSON 2631 S PACKERLAND DRIVE #104F GREEN BAY, WI 54303 County: Brown MsLars2@aol.com Phone: (920) 884-1144 Fax: (920) 336-5959 Surveyor: Frank Bellaire 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 08/28/2003 09/01/2009 08/31/2010 Mental Health Outpatient Clinic DHS 35 2354 LAUREN MURPHY PAYNE & ASSOCIATES, LLC LAUREN MURPHY PAYNE 6021 DURAND AVENUE, #300 RACINE, WI 53406 County: Racine lmpandassoc@sbcglobal.net Phone: (262) 554-0126 Fax: (262) 554-0127 Surveyor: Mark Isaacs Services NO BRANCH LOCATIONS 08/01/2011 07/31/2013 08/01/2011 07/31/2013 Administrative Code Chapter Service Begin/End Dates 03/01/2002 03/01/2009 02/28/2011 Mental Health-Outpatient DHS 61.91 NO BRANCH LOCATIONS 09/01/2009 08/31/2010 Administrative Code Chapter Service Begin/End Dates 03/01/2009 02/28/2011
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 159 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2046 LEES PSYCHOLOGICAL SERVICES, INC. LAURA A. LEES, PSYD 601 N 99TH STREET, #307 WAUWATOSA, WI 53226 County: Milwaukee heartandmindmatters.com Phone: (414) 774-6878 Fax: (414) 774-6879 Surveyor: Mark Isaacs Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 09/25/1998 10/01/2011 09/30/2013 Mental Health Outpatient Clinic DHS 35 2869 LEPAK-JOSTSONS, INC DBA DYNAMIC FAMILY SOLUTIONS JANE A LEPAK-JOSTSONS 615 SOUTH 8TH ST SUITE 220 SHEBOYGAN, WI 53081 County: Sheboygan dfsjanelepakjostsons@excel.net Phone: (920) 323-2188 Fax: (920) 358-5970 Surveyor: Frank Bellaire 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 08/19/2009 09/01/2012 08/31/2014 Mental Health Outpatient Clinic DHS 35 2113 LIBERTAS OF MARINETTE PATRICK RYAN 1712 DUNLAP SQUARE BLDG, #5 MARINETTE, WI 54143 County: Marinette pryan@sjcf.hshs.org Phone: (715) 735-0095 Fax: (715) 735-0094 Surveyor: Frank Bellaire Services 10/01/2011 09/30/2013 DYNAMIC FAMILY SOLUTIONS Tier 1 W1236 HWY FF 09/01/2012 HAVEN, WI 53083 08/31/2014 DYNAMIC FAMILY SOLUTIONS Tier 2 ONE WALDO BLVD SUITE 3 09/01/2012 MANITOWOC, WI 54220 08/31/2014 DYNAMIC FAMILY SOLUTIONS Tier 2 3021 HOLMGREN WAY 09/01/2012 GREEN BAY, WI 54305 08/31/2014 Administrative Code Chapter Service Begin/End Dates 05/18/1999 06/01/2012 05/31/2014 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 09/01/2012 08/31/2014 Administrative Code Chapter Service Begin/End Dates 06/01/2012 05/31/2014
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Mental Health and Substance Abuse Programs in alphabetical

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