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 206 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1796 MINISTRY MEDICAL GROUP-PSYCHIATRY DEPARTMENT LINDA MASSOPUST 3398 E. MARIA DRIVE STEVENS POINT, WI 54481 County: Portage linda.massopust@ministryhealth.org Phone: (715) 341-7441 Fax: (715) 343-2088 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 12/01/1983 01/01/2012 12/31/2013 Mental Health Outpatient Clinic DHS 35 1915 MONROE CLINIC BEHAVIORAL HEALTH TODD NOGGLE 515 - 22ND AVENUE MONROE, WI 53566 County: Green todd.noggle@monroeclinic.org Phone: (608) 324-2321 Fax: (608) 324-2102 Surveyor: William Rohner 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 05/01/1981 08/01/2012 07/31/2014 Mental Health Outpatient Clinic DHS 35 2282 MONROE COUNTY COMMUNITY SUPPORT PROGRAM SUSAN RETTLER 14301 HWY B, COMM SVS CTR A-19 SPARTA, WI 54656 County: Monroe srettler@co.monroe.wi.us Phone: (608) 269-8630 Fax: (608) 269-8935 Surveyor: Polly Wong Services NEW GLARUS BRANCH OF MONROE CLINIC 1800 - 2ND ST NEW GLARUS, WI 53574 01/01/2012 12/31/2013 Tier 1 08/01/2012 07/31/2014 Administrative Code Chapter Service Begin/End Dates 12/01/1999 12/01/2010 11/30/2012 Mental Health-Community Support Program DHS 63 NO BRANCH LOCATIONS 08/01/2012 07/31/2014 Administrative Code Chapter Service Begin/End Dates 12/01/2010 11/30/2012
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 207 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1654 MONROE COUNTY DEPARTMENT OF HUMAN SERVICES SUSAN RETTLER 14301 HWY B, COMM SVS CTR A-19 SPARTA, WI 54656 County: Monroe srettler@co.monroe.wi.us Phone: (608) 269-8630 Fax: (608) 269-8935 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 10/01/1975 12/01/2010 11/30/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Emergency Outpatient DHS 75.05 CSAS-Outpatient Treatment DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 2613 MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. TONY MOORE 6530 SHERIDAN ROAD, #3 KENOSHA, WI 53143 County: Kenosha Tmoore@mooreandassociates.biz Phone: (262) 605-1444 Fax: (262) 605-1404 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 09/14/2005 04/01/2012 09/30/2013 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 1917 MOORING PROGRAMS, INC. JAMIE LOEHNIS 607 W. SEVENTH STREET APPLETON, WI 54911 County: Outagamie Jamie@mooringcasa.com Phone: (920) 739-3235 Fax: (920) 731-4796 Surveyor: Frank Bellaire Services MOORE AND ASSOC, INC/HARVEST CONSULTING 2405 NORTHWESTERN AVENUE, #105 RACINE, WI 53404 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012 Tier 1 04/01/2012 09/30/2013 Administrative Code Chapter Service Begin/End Dates 05/08/1991 07/01/2012 06/30/2014 CSAS-Emergency Outpatient DHS 75.05 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Outpatient Treatment DHS 75.13 CSAS-Residential Intoxication Monitoring DHS 75.09 CSAS-Transitional Residential DHS 75.14 NO BRANCH LOCATIONS 04/01/2012 09/30/2013 04/01/2012 09/30/2013 Administrative Code Chapter Service Begin/End Dates 07/01/2012 06/30/2014 07/01/2012 06/30/2014 07/01/2012 06/30/2014 07/01/2012 06/30/2014 07/01/2012 06/30/2014
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