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 189 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2510<br />
MAYO CLINIC HEALTH SYSTEM-FRANCISAN<br />
MEDICAL CENTER, INC - WOMEN'S LAAR HOUSE<br />
PAMELA REYNOLDS<br />
1005 JACKSON STREET<br />
LA CROSSE, WI 54601<br />
County: La Crosse<br />
reynolds.pamela@mayo.edu<br />
Phone: (608) 392-6147<br />
Fax: (608) 392-9511<br />
Surveyor: Polly Wong<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 />
03/19/2004<br />
04/01/2012<br />
03/31/2014<br />
CSAS-Medically Monitored Treatment DHS 75.11<br />
CSAS-Transitional Residential DHS 75.14<br />
1580<br />
MCW DEPARTMENT OF PSYCHIATRY CLINICS AT<br />
TOSA<br />
JEFFREY G MILLER<br />
1155 N. MAYFAIR ROAD<br />
MILWAUKEE, WI 53226<br />
County: Milwaukee<br />
No Email Address Provided<br />
Phone: (414) 955-8900<br />
Fax: (414) 955-6295<br />
Surveyor: Demetrius Anderson<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 />
07/01/1996<br />
02/01/2011<br />
01/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
2225<br />
MD THERAPY<br />
THOMAS (MIKE) DALE<br />
6815 W CAPITOL DRIVE, #208<br />
MILWAUKEE, WI 53216<br />
County: Milwaukee<br />
mdtherapybh@aol.com<br />
Phone: (414) 466-3204<br />
Fax: (414) 466-3206<br />
Surveyor: Demetrius Anderson<br />
Services<br />
04/01/2012 03/31/2014<br />
04/01/2012 03/31/2014<br />
MCW DPT PSYCH CLINICS @ COMM MEM<br />
MED COM<br />
W129 N7055 NORTHFIELD DRIVE, #301<br />
MENOMONEE FALLS, WI 53051<br />
Tier 2<br />
02/01/2011<br />
01/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
05/05/2000<br />
06/01/2012<br />
05/31/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
NO BRANCH LOCATIONS<br />
02/01/2011 01/31/2013<br />
02/01/2011 01/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
06/01/2012 05/31/2014<br />
06/01/2012 05/31/2014
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