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 252 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2828 RACINE COMMUNITY HEALTH CENTER AMY BARBER 2405 NORTHWESTERN AVENUE RACINE, WI 53404 County: Racine No Email Address Provided Phone: (262) 886-0474 Fax: (262) 886-1672 Surveyor: Mark Isaacs Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/01/2008 07/01/2010 08/04/2010 Mental Health Outpatient Clinic DHS 35 2952 RACINE COUNTY HUMAN SERVICES DEPARTMENT COMMUNITY SUPPORT PROGRAM MICHELLE GOGGINS 1717 TAYLOR AVENUE RACINE, WI 53403 County: Racine michelle.goggins@goracine.org Phone: (262) 638-6633 Fax: (262) 638-6983 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 12/01/2011 12/01/2011 11/30/2012 Mental Health-Community Support Program DHS 63 2490 RACINE COUNTY HUMAN SERVICES DEPARTMENT MICHELLE GOGGINS 1717 TAYLOR AVENUE RACINE, WI 53403 County: Racine michelle.goggins@goracine.org Phone: (262) 638-6633 Fax: (262) 638-6978 Surveyor: Mark Isaacs Services NO BRANCH LOCATIONS 07/01/2010 08/04/2010 Administrative Code Chapter Service Begin/End Dates 01/14/2004 01/01/2012 12/31/2012 CSAS-Emergency Outpatient DHS 75.05 Mental Health-Emergency Service 3 DHS 34.3 NO BRANCH LOCATIONS 12/01/2011 11/30/2012 Administrative Code Chapter Service Begin/End Dates 08/02/2012 12/31/2012 01/01/2012 12/31/2012
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 253 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2220 RACINE PSYCHOLOGICAL SERVICES, INC. MARY JANE WHITMORE 840 LAKE AVENUE, #101 RACINE, WI 53403 County: Racine RacinePsychSvc@aol.com Phone: (262) 634-8688 Fax: (262) 634-7547 Surveyor: Mark Isaacs Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 03/31/2000 04/01/2011 03/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2118 RAVENSWOOD CLINIC ANTHONY F. WERTH, JR. 2266 N. PROSPECT AVENUE, #326 MILWAUKEE, WI 53202 County: Milwaukee awerth@ravenswoodclinic.org Phone: (414) 224-0492 Fax: (414) 224-8112 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 RACINE PSYCHOLOGICAL SERVICES INC Tier 1 209 N MAIN STREET 04/01/2011 BURLINGTON, WI 53105 03/31/2013 RACINE PSYCHOLOGICAL SERVICES, INC. Tier 2 1717 TAYLOR AVE 11/25/2011 RACINE, WI 53403 03/31/2013 Administrative Code Chapter Service Begin/End Dates 06/23/1999 09/01/2011 08/31/2013 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 2750 RAWHIDE YOUTH & FAMILY COUNSELING SERVICES KELLY WISNEFSKE E7475 RAWHIDE ROAD NEW LONDON, WI 54961 County: Waupaca Kwisnefske@rawhide.org Phone: (877) 300-9101 Fax: (920) 982-5040 Surveyor: Frank Bellaire Services NO BRANCH LOCATIONS 04/01/2011 03/31/2013 04/01/2011 03/31/2013 Administrative Code Chapter Service Begin/End Dates 08/23/2007 09/01/2011 08/31/2013 Mental Health Outpatient Clinic DHS 35 RAWHIDE YOUTH & FAMILY COUNSELING SVS 446 WESTHILL BLVD SUITE 6 APPLETON, WI 54914 RAWHIDE YOUTH & FAMILY COUNSELING SVS 926 WILLARD DRIVE SUITE 228 GREEN BAY, WI 54303 RAWHIDE YOUTH & FAMILY COUNSELING SVS 6045 N GREEN BAY AVENUE GLENDALE, WI 53209 RAWHIDE YOUTH & FAMILY COUNSELING SVS 303 N MAIN STREET, #201 WEST BEND, WI 53095 09/01/2011 08/31/2013 09/01/2011 08/31/2013 Tier 1 09/14/2011 08/31/2013 Tier 1 09/01/2011 08/31/2013 Tier 1 09/01/2011 08/31/2013 Tier 1 09/01/2011 08/31/2013 Administrative Code Chapter Service Begin/End Dates 09/01/2011 08/31/2013
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Mental Health and Substance Abuse Programs in alphabetical

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