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 240 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2222 POLK COUNTY HUMAN SERVICES DEPARTMENT CSP LINDA MILLS-KREBSBACH 100 POLK COUNTY PLAZA, #50 BALSAM LAKE, WI 54810 County: Polk lindamk@co.polk.wi.us Phone: (715) 485-8400 Fax: (715) 485-8490 Surveyor: Polly Wong Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 01/26/2000 05/01/2012 04/30/2014 Mental Health-Community Support Program DHS 63 2204 POLK COUNTY MENTAL AND BEHAVIORAL HEALTH SERVICES KAY CONFER 100 POLK COUNTY PLAZA, #50 BALSAM LAKE, WI 54810 County: Polk kayC@co.polk.wi.us Phone: (715) 485-8400 Fax: (715) 485-8490 Surveyor: Polly Wong 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 02/08/2000 05/01/2012 04/30/2014 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 2712 PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES AMY MARCOTT 817 WHITING AVENUE STEVENS POINT, WI 54481 County: Portage marcotta@co.portage.wi.us Phone: (715) 345-5350 Fax: (715) 345-5966 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 05/01/2012 04/30/2014 Administrative Code Chapter Service Begin/End Dates 03/01/2007 03/01/2011 02/28/2013 Comprehensive Community Services (CCS) DHS 36 NO BRANCH LOCATIONS 05/01/2012 04/30/2014 05/01/2012 04/30/2014 05/01/2012 04/30/2014 Administrative Code Chapter Service Begin/End Dates 03/01/2011 02/28/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 241 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1740 PORTAGE COUNTY HEALTH & HUMAN SERVICES AMY MARCOTT 817 WHITING AVENUE STEVENS POINT, WI 54481 County: Portage marcotta@co.portage.wi.us Phone: (715) 345-5810 Fax: (715) 345-5966 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 06/01/1976 04/01/2011 03/31/2013 Mental Health Outpatient Clinic DHS 35 Mental Health-Emergency Service 3 DHS 34.3 2773 PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC LLC ALICE PORTIS-PATTERSON 5801 WASHINGTON AVENUE, #110 RACINE, WI 53406 County: Racine pmccounseling@wi.twcbc.com Phone: (262) 884-9734 Fax: (262) 884-9735 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 02/05/2008 03/01/2011 02/28/2013 Mental Health Outpatient Clinic DHS 35 2796 POSITIVE OUTLOOK CLINICAL SERVICES LLC PAMELA HANSEN 3353 N DR MARTIN LUTHER KING DRIVE MILWAUKEE, WI 53212 County: Milwaukee Positiveoutlook2006@yahoo.com Phone: (414) 460-6995 Fax: (414) 355-5467 Surveyor: Demetrius Anderson Services NO BRANCH LOCATIONS 04/01/2011 03/31/2013 04/01/2011 03/31/2013 Administrative Code Chapter Service Begin/End Dates 08/01/2008 08/01/2011 07/31/2013 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 03/01/2011 02/28/2013 Administrative Code Chapter Service Begin/End Dates 08/01/2011 07/31/2013
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