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 218 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2685 NORTHERN CROSSING BEHAVIORAL HEALTH SERVICES, LLC FRED JONES 5303 W NORTH AVENUE MILWAUKEE, WI 53208 County: Milwaukee northerncrossingbh@gmail.com Phone: (414) 445-0997 Fax: (414) 445-0989 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 05/01/2006 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2878 NORTHERN HEALTH CENTERS INC. NICOLET MEDICAL & DENTAL CLINIC JODI MARSH 15397 HIGHWAY 32 LAKEWOOD, WI 54138 County: Oconto No Email Address Provided Phone: (715) 276-6321 Fax: (715) 276-1428 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 07/24/2009 08/01/2012 07/31/2014 Mental Health Outpatient Clinic DHS 35 2262 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM DR JON MATTHEW 161 SPRING STREET WESTFIELD, WI 53964 County: Marquette ncs@maq.net Phone: (608) 296-2139 Fax: (608) 296-1590 Surveyor: William Goehring Services NO BRANCH LOCATIONS 05/01/2011 04/30/2013 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 01/01/1983 11/01/2011 10/31/2013 Mental Health-Community Support Program DHS 63 NO BRANCH LOCATIONS 08/01/2012 07/31/2014 Administrative Code Chapter Service Begin/End Dates 11/01/2011 10/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 219 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2330 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM CAROL LUND 10270 OLKER ROAD HAYWARD, WI 54843 County: Sawyer northlandcsp@centurytel.net Phone: (715) 634-2522 Fax: (715) 634-2533 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 02/01/2001 09/01/2010 08/31/2012 Mental Health-Community Support Program DHS 63 1693 NORTHLAND COMMUNITY SERVICES DR JON MATTHEW 161 SPRING STREET WESTFIELD, WI 53964 County: Marquette ncs@maq.net Phone: (608) 296-2139 Fax: (608) 296-1590 Surveyor: William Goehring 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 01/01/1983 11/01/2011 10/31/2013 Mental Health Outpatient Clinic DHS 35 Mental Health-Emergency Service 3 DHS 34.3 2213 NORTHLAND COUNSELING SERVICES, LTD. CAROL LUND 10752 BEAL STREET HAYWARD, WI 54843 County: Sawyer northland006@centurytel.net Phone: (715) 634-0222 Fax: (715) 634-1722 Surveyor: Bradley Jahr Services 09/01/2010 08/31/2012 NORTHLAND COMMUNITY SERVICES Tier 1 139 S MAIN, PO BOX 1178 11/01/2011 ADAMS, WI 53910 10/31/2013 Administrative Code Chapter Service Begin/End Dates 04/03/2000 04/01/2012 03/31/2014 Mental Health Outpatient Clinic DHS 35 NORTHLAND COUNSELING SERVICES LTD 16096 US HWY 63 HAYWARD, WI 54843 NORTHLAND COUNSELING SERVICES LTD 10270 OKLER ROAD HAYWARD, WI 54843 11/01/2011 10/31/2013 11/01/2011 10/31/2013 Tier 1 04/12/2012 03/31/2014 Tier 1 04/01/2012 03/31/2014 Administrative Code Chapter Service Begin/End Dates 04/01/2012 03/31/2014
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