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 170 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2872 LUTHERAN SOCIAL SERVICES SIGNA MEYERS 3003-A NORTH RICHMOND ST APPLETON, WI 54911 County: Outagamie signa.meyers@lsswis.org Phone: (920) 730-1330 Fax: (920) 734-2824 Surveyor: Frank Bellaire Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 06/02/2009 08/01/2012 07/31/2014 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates LUTHERAN SOCIAL SERVICES Tier 1 706 N 9TH STREET 08/01/2012 SHEBOYGAN, WI 53081 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 1 901 HARRISON DRIVE 08/01/2012 BELOIT, WI 53511 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 2 820 W COLLEGE AVENUE 08/01/2012 APPLETON, WI 54914 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 2 612 N RANDALL STREET 08/01/2012 JANESVILLE, WI 53545 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 2 6314 ODANA ROAD 08/01/2012 MADISON, WI 53719 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 1 550 LINCOLN DRIVE 08/01/2012 SUN PRAIRIE, WI 53590 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 2 809 N PARK AVENUE 08/01/2012 BEAVER DAM, WI 53916 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 1 115 NORTH 6TH STREET 08/01/2012 WAUSAU, WI 54403 07/31/2014 LUTHERAN SOCIAL SERVICES Tier 1 727 - 8TH STREET 08/01/2012 BARABOO, WI 53913 07/31/2014 LUTHERAN SS ALCOHOL & DRUG RESOUCE CTR Tier 1 131 S MAIN STREET 08/01/2012 FOND DU LAC, WI 54935 07/31/2014 Administrative Code Chapter Service Begin/End Dates 08/01/2012 07/31/2014 08/01/2012 07/31/2014 08/01/2012 07/31/2014 08/01/2012 07/31/2014
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 171 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1529 LUTHERAN SOCIAL SERVICES-FAHRMAN CENTER RICHARD WILLIAMS 3136 CRAIG ROAD EAU CLAIRE, WI 54701 County: Eau Claire dwilliam@lsswis.org Phone: (715) 835-9110 Fax: (715) 830-4098 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 11/01/1986 07/01/2012 06/30/2014 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Transitional Residential DHS 75.14 1539 LUTHERAN SOCIAL SERVICES-RACINE TERI GUMIENY 2219 WASHINGTON AVENUE RACINE, WI 53403 County: Racine teri.gumieny@lsswis.org Phone: (262) 637-3886 Fax: (414) 645-7850 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 04/01/1989 12/01/2008 11/30/2010 Mental Health-Outpatient DHS 61.91 2130 LUTHERAN SOCIAL SERVICES-TOUCHSTONES CENTER MARGARET BEHNKE 122 SOUTH BARSTOW ST SUITE 1 EAU CLAIRE, WI 54701 County: Eau Claire margaret.benke@lsswis.org Phone: (715) 855-1373 Fax: (715) 855-1375 Surveyor: Polly Wong Services NO BRANCH LOCATIONS 07/01/2012 06/30/2014 07/01/2012 06/30/2014 Administrative Code Chapter Service Begin/End Dates 07/01/1999 07/01/2012 06/30/2014 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 12/01/2008 11/30/2010 Administrative Code Chapter Service Begin/End Dates 07/01/2012 06/30/2014
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