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 220 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2361 NORTHLAND COUNSELING SERVICES JEREMY KOEHL 21 W OMAHA STREET WASHBURN, WI 54891 County: Bayfield northland006@centurytel.net Phone: (715) 373-0160 Fax: (715) 373-0162 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/01/2001 07/01/2012 06/30/2014 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1695 NORTHSHORE CLINIC & CONSULTANTS, INC. JOY MYERS W62 N248 WASHINGTON AVE., #207 CEDARBURG, WI 53012 County: Ozaukee joymyersnsc@yahoo.com Phone: (262) 375-1116 Fax: (262) 375-1071 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 NORTHLAND COUNSELING SERVICES Tier 1 611 E WALL STREET 07/01/2012 EAGLE RIVER, WI 54521 06/30/2014 NORTHLAND COUNSELING SERVICES Tier 1 1619 WEST THIRD STREET 07/01/2012 ASHLAND, WI 54806 06/30/2014 Administrative Code Chapter Service Begin/End Dates 10/01/1987 08/01/2012 07/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1699 NORTHSHORE CLINIC OF SHEBOYGAN, INC. SUE BALOG 615 S. 8TH STREET, #G20 SHEBOYGAN, WI 53081 County: Sheboygan nsc@northshoreclinic.org Phone: (920) 457-8866 Fax: (920) 457-8867 Surveyor: William Goehring Services 07/01/2012 06/30/2014 07/01/2012 06/30/2014 NORTHSHORE CLINIC & CONSULTANTS Tier 1 207 E BUFFALO STREET, #510 08/01/2012 MILWAUKEE, WI 53202 07/31/2013 NORTHSHORE CLINIC & CONSULTANTS Tier 2 2363 S 102ND STREET, #203 08/01/2012 WEST ALLIS, WI 53227 07/31/2013 NORTHSHORE CLINIC & CONSULTANTS, INC Tier 2 2607 N GRANDVIEW BLVD, #104 08/01/2012 WAUKESHA, WI 53188 07/31/2013 NORTHSHORE CLINIC & CONSULTANTS, INC. Tier 2 1615 BARTON AVENUE 08/01/2012 WEST BEND, WI 53090 07/31/2013 Administrative Code Chapter Service Begin/End Dates 08/01/1991 08/01/2011 07/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 08/01/2012 07/31/2013 08/01/2012 07/31/2013 Administrative Code Chapter Service Begin/End Dates 08/01/2011 07/31/2013 08/01/2011 07/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 221 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1685 NORTHSTAR COUNSELING CENTER BEN FARBMAN 700 RAYOVAC DRIVE, #010 MADISON, WI 53711 County: Dane b_farbman@yahoo.com Phone: (608) 270-1960 Fax: (608) 270-1965 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 11/01/1991 11/01/2010 10/31/2012 Mental Health Outpatient Clinic DHS 35 Mental Health-Day Treatment for Children 1 DHS 40.11(2)(a) 2254 NORTHWEST COUNSELING AND GUIDANCE CLINIC ANN PARDUN 203 UNITED WAY DRIVE FREDERIC, WI 54837 County: Polk annp@nwcg.com Phone: (715) 327-4402 Fax: (715) 327-8447 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 NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 08/25/1999 02/01/2012 01/31/2014 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Outpatient Treatment DHS 75.13 2924 NORTHWEST DIRECTIONS - MENOMONIE MARC WIEHL 402 TECHNOLOGY DRIVE EAST MENOMONIE, WI 54751 County: Dunn nwdmenomonie@nwcgc.com Phone: (715) 450-5241 Fax: (715) 235-4421 Surveyor: Polly Wong Services 11/01/2010 10/31/2012 11/01/2010 10/31/2012 NORTHWEST PASSAGE 1 Tier 2 7818 MOLINE RD, PO BOX 349 02/01/2012 WEBSTER, WI 54893 01/31/2014 NORTHWEST PASSAGE II Tier 1 1661 HAMMS ROAD 02/01/2012 SPOONER, WI 54801 01/31/2014 Administrative Code Chapter Service Begin/End Dates 07/26/2010 02/01/2012 01/31/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 02/01/2012 01/31/2014 02/01/2012 01/31/2014 02/01/2012 01/31/2014 NORTHWEST DIRECTIONS-BLACK RIVER FALLS Tier 1 N6643 COUNTY ROAD A 02/01/2012 BLACK RIVER FALLS, WI 54615 01/31/2013 NORTHWEST DIRECTIONS-CHIPPEWA FALLS Tier 1 705 BAY STREET, #2E 02/01/2012 CHIPPEWA FALLS, WI 54729 01/31/2013 NORTHWEST DIRECTIONS-RIVER FALLS Tier 1 2860 WILLIAMS AVENUE 02/01/2012 RIVER FALLS, WI 54022 01/31/2013 Administrative Code Chapter Service Begin/End Dates 02/01/2012 01/31/2013 02/01/2012 01/31/2013
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