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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 174 of 335<br />

Certification Number/<br />

Certified Provider's Ma<strong>in</strong> Site/<br />

Email/Telephone<br />

2399<br />

MALEN & ASSOCIATES<br />

No Contact Name Provided<br />

759 N. MILWAUKEE STREET, #200<br />

MILWAUKEE, WI 53202<br />

County: Milwaukee<br />

No Email Address Provided<br />

Phone: (414) 271-1718<br />

Fax: No Number Provided<br />

Surveyor: Demetrius Anderson<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 />

10/01/2002<br />

08/01/2007<br />

07/31/2009<br />

<strong>Mental</strong> <strong>Health</strong>-Outpatient DHS 61.91<br />

2285<br />

MANITOWOC COUNTY HUMAN SERVICES<br />

DEPARTMENT CSP<br />

JEFF JENSWOLD<br />

926 S. 8TH STREET<br />

MANITOWOC, WI 54221<br />

County: Manitowoc<br />

humanservices@co.manitowoc.wi.us<br />

Phone: (920) 683-4300<br />

Fax: (920) 683-4243<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 />

NO BRANCH LOCATIONS<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

10/01/1975<br />

12/01/2011<br />

10/31/2013<br />

<strong>Mental</strong> <strong>Health</strong>-Com Support Program w/Telehealth DHS 63<br />

<strong>Mental</strong> <strong>Health</strong>-Community Support Program DHS 63<br />

1555<br />

MANITOWOC COUNTY HUMAN SERVICES<br />

DEPARTMENT<br />

JEFF JENSWOLD<br />

926 S. 8TH STREET<br />

MANITOWOC, WI 54221<br />

County: Manitowoc<br />

humanservices@co.manitowoc.wi.us<br />

Phone: (920) 683-4300<br />

Fax: (920) 683-4243<br />

Surveyor: Frank Bellaire<br />

Services<br />

NO BRANCH LOCATIONS<br />

08/01/2007 07/31/2009<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

10/01/1975<br />

12/01/2011<br />

10/31/2013<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 Outpatient DHS 75.05<br />

CSAS-Outpatient Treatment DHS 75.13<br />

CSAS-Outpatient Treatment with Telehealth DHS 75.13<br />

<strong>Mental</strong> <strong>Health</strong>-Emergency Service 3 DHS 34.3<br />

NO BRANCH LOCATIONS<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013<br />

Adm<strong>in</strong>istrative<br />

Code Chapter Service Beg<strong>in</strong>/End Dates<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013<br />

12/01/2011 10/31/2013

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