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 190 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1578 MEDICAL AND COUNSELING ASSOCIATES ANN DAKE N5367 MAYFLOWER RD SHIOCTON, WI 54170 County: Outagamie adake@chapsacademy.org Phone: (920) 986-3003 Fax: (920) 986-3004 Surveyor: Frank Bellaire Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 01/01/1986 02/01/2012 01/31/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 Mental Health-Day Treat/Children 1 w/Telehealth DHS 40.11(2)(a) Mental Health-Day Treatment for Children 1 DHS 40.11(2)(a) 2530 MELONAS COUNSELING SERVICES, LLC IRENE MELONAS 726 E SECOND STREET MERRILL, WI 54452 County: Lincoln melonascounseling@charterinternet.com Phone: (715) 536-4440 Fax: (715) 536-2736 Surveyor: Bradley Jahr Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates MEDICAL & COUNSELING ASSOCIATES KAUKAUNA 2416 CROOKS AVENUE KAUKAUNA, WI 54130 MEDICAL AND COUNSELING ASSOCIATES 300 N WOODS EDGE DR APPLETON, WI 54914 Tier 1 02/01/2012 01/31/2013 Tier 1 02/01/2012 01/31/2013 Administrative Code Chapter Service Begin/End Dates 07/01/2004 01/01/2010 06/30/2011 Mental Health Outpatient Clinic DHS 35 1577 MEMORIAL HEALTH CENTER CLINICS-MEDFORD, BEHAVIORAL HEALTH SERVICES DOREEN ELDRED 143 S. GIBSON STREET MEDFORD, WI 54451 County: Taylor doreen.eldred@aspirus.org Phone: (715) 748-2121 Fax: (715) 748-8197 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 02/01/2012 01/31/2013 02/01/2012 01/31/2013 02/01/2012 01/31/2013 02/01/2012 01/31/2013 Administrative Code Chapter Service Begin/End Dates 01/01/1978 07/01/2012 06/30/2014 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 01/01/2010 06/30/2011 Administrative Code Chapter Service Begin/End Dates 07/01/2012 06/30/2014
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 191 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2228 MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT CSP RACHEL KIELBLOCK W3272 WOLF RIVER ROAD KESHENA, WI 54135 County: Menominee No Email Address Provided Phone: (715) 799-3861 Fax: (715) 799-3517 Surveyor: Frank Bellaire Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 11/01/1994 05/01/2011 04/30/2013 Mental Health-Community Support Program DHS 63 1587 MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT BARBARA NELSON W3272 WOLF RIVER ROAD KESHENA, WI 54135 County: Menominee barbexdir@co.menominee.wi.us Phone: (715) 799-3861 Fax: (715) 799-3517 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 11/01/1994 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Emergency Outpatent with Telehealth DHS 75.05 CSAS-Emergency Outpatient DHS 75.05 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 Mental Health-Emergency Service 3 w/Telehealth DHS 34.3 1588 MENOMINEE TRIBAL CLINIC, BEHAVIORAL HEALTH SERVICES STEPHEN EISFELDER W3275 WOLF RIVER DRIVE KESHENA, WI 54135 County: Menominee stevee@mtclinic.net Phone: (715) 799-5451 Fax: (715) 799-3929 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 03/03/1993 06/01/2011 02/28/2013 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 06/01/2011 02/28/2013
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