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 160 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1504 LIBERTAS OF SHEBOYGAN PATRICK RYAN 2108 KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 53081 County: Sheboygan pryan@sjcf.hshs.org Phone: (920) 803-0740 Fax: (920) 803-0739 Surveyor: William Goehring Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 01/16/1988 04/01/2011 03/31/2013 CSAS-Outpatient Treatment DHS 75.13 1505 LIBERTAS TREATMENT CENTER PATRICK RYAN 1701 DOUSMAN STREET GREEN BAY, WI 54303 County: Brown pryan@sjcf.hshs.org Phone: (920) 498-8600 Fax: (920) 496-2027 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 09/01/1986 04/01/2011 03/31/2013 CSAS-Medically Managed Inpatient Detox DHS 75.06 CSAS-Medically Managed Inpatient Treatment DHS 75.10 CSAS-Outpatient Treatment DHS 75.13 2661 LIBERTY COUNSELING & WELLNESS CENTER CHAR GROVES 151 E PARK AVENUE BERLIN, WI 54923 County: Green Lake charlotgrov@aol.com Phone: (920) 290-0107 Fax: (920) 361-2334 Surveyor: William Goehring Services NO BRANCH LOCATIONS 04/01/2011 03/31/2013 Administrative Code Chapter Service Begin/End Dates 04/06/2006 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 04/01/2011 03/31/2013 04/01/2011 03/31/2013 04/01/2011 03/31/2013 LIBERTY COUNSELING Tier 1 489 SCOTT STREET 05/01/2011 GREEN LAKE, WI 54941 04/30/2012 Administrative Code Chapter Service Begin/End Dates 05/01/2011 04/30/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 161 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2677 LIFE POINT COUNSELING, LLC KATHLYN M HUNHOLZ 433 A EAST MILL STREET PLYMOUTH, WI 53073 County: Sheboygan lifepoint@verizon.net Phone: (920) 892-7606 Fax: (920) 449-4247 Surveyor: William Goehring Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/06/2006 08/01/2012 07/31/2014 CSAS-Outpatient Treatment DHS 75.13 1507 LIFE SPAN PSYCHOLOGICAL SERVICES, LLC THOMAS S. LEHMANN 13035 W BLUEMOUND ROAD, #100 BROOKFIELD, WI 53005 County: Waukesha lifespan7777@yahoo.com Phone: (262) 784-1121 Fax: (262) 784-9777 Surveyor: Mark Isaacs 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 11/01/1989 11/01/2011 10/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1509 LIGHTHOUSE CLINIC, LLC MARGO RENNER 2524 E WEBSTER PLACE, #203 MILWAUKEE, WI 53211 County: Milwaukee lighthouseclinic@gmail.com Phone: (414) 964-9200 Fax: (414) 964-4816 Surveyor: William Goehring Services LIFE-SPAN PSYCHOLOGICAL SERVICES, LLC 2266 N PROSPECT AVENUE, #503 MILWAUKEE, WI 53202 LIFE-SPAN PSYCHOLOGICAL SERVICES, LLC 11803 W NORTH AVENUE MILWAUKEE, WI 53226 08/01/2012 07/31/2014 Tier 1 11/01/2011 10/31/2013 Tier 1 11/01/2011 10/31/2013 Administrative Code Chapter Service Begin/End Dates 01/01/1990 02/01/2012 01/31/2014 Mental Health Outpatient Clinic DHS 35 11/01/2011 10/31/2013 11/01/2011 10/31/2013 LIGHTHOUSE CLINIC Tier 1 11520 N PT WASHINGTON ROAD 02/01/2012 MEQUON, WI 53092 01/31/2014 LIGHTHOUSE CLINIC Tier 1 11803 W NORTH AVENUE, #207 02/01/2012 MILWAUKEE, WI 53226 01/31/2014 Administrative Code Chapter Service Begin/End Dates 02/01/2012 01/31/2014
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