Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
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DEPARTMENT OF HEALTH SERVICES<br />
Division of Quality Assurance<br />
Pr<strong>in</strong>t Date: 08/28/2012<br />
Page 253 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2220<br />
RACINE PSYCHOLOGICAL SERVICES, INC.<br />
MARY JANE WHITMORE<br />
840 LAKE AVENUE, #101<br />
RACINE, WI 53403<br />
County: Rac<strong>in</strong>e<br />
Rac<strong>in</strong>ePsychSvc@aol.com<br />
Phone: (262) 634-8688<br />
Fax: (262) 634-7547<br />
Surveyor: Mark Isaacs<br />
Services<br />
Community <strong>Substance</strong> <strong>Abuse</strong> <strong>and</strong> <strong>Mental</strong> <strong>Health</strong><br />
Program Certification Directory<br />
By Provider Name & Certification Number<br />
Initial Certification/<br />
Certification Effective/<br />
Certification Expires<br />
03/31/2000<br />
04/01/2011<br />
03/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
2118<br />
RAVENSWOOD CLINIC<br />
ANTHONY F. WERTH, JR.<br />
2266 N. PROSPECT AVENUE, #326<br />
MILWAUKEE, WI 53202<br />
County: Milwaukee<br />
awerth@ravenswoodcl<strong>in</strong>ic.org<br />
Phone: (414) 224-0492<br />
Fax: (414) 224-8112<br />
Surveyor: William Goehr<strong>in</strong>g<br />
Services<br />
STATE OF WISCONSIN<br />
Bureau of <strong>Health</strong> Services<br />
PO Box 2969<br />
Madison, WI 53701-2969<br />
Tier/<br />
Branch Beg<strong>in</strong>/<br />
Branch Location(s) End Dates<br />
RACINE PSYCHOLOGICAL SERVICES INC Tier 1<br />
209 N MAIN STREET<br />
04/01/2011<br />
BURLINGTON, WI 53105<br />
03/31/2013<br />
RACINE PSYCHOLOGICAL SERVICES,<br />
INC.<br />
Tier 2<br />
1717 TAYLOR AVE<br />
11/25/2011<br />
RACINE, WI 53403<br />
03/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
06/23/1999<br />
09/01/2011<br />
08/31/2013<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Outpatient Treatment DHS 75.13<br />
2750<br />
RAWHIDE YOUTH & FAMILY COUNSELING<br />
SERVICES<br />
KELLY WISNEFSKE<br />
E7475 RAWHIDE ROAD<br />
NEW LONDON, WI 54961<br />
County: Waupaca<br />
Kwisnefske@rawhide.org<br />
Phone: (877) 300-9101<br />
Fax: (920) 982-5040<br />
Surveyor: Frank Bellaire<br />
Services<br />
NO BRANCH LOCATIONS<br />
04/01/2011 03/31/2013<br />
04/01/2011 03/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
08/23/2007<br />
09/01/2011<br />
08/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
RAWHIDE YOUTH & FAMILY<br />
COUNSELING SVS<br />
446 WESTHILL BLVD SUITE 6<br />
APPLETON, WI 54914<br />
RAWHIDE YOUTH & FAMILY<br />
COUNSELING SVS<br />
926 WILLARD DRIVE SUITE 228<br />
GREEN BAY, WI 54303<br />
RAWHIDE YOUTH & FAMILY<br />
COUNSELING SVS<br />
6045 N GREEN BAY AVENUE<br />
GLENDALE, WI 53209<br />
RAWHIDE YOUTH & FAMILY<br />
COUNSELING SVS<br />
303 N MAIN STREET, #201<br />
WEST BEND, WI 53095<br />
09/01/2011 08/31/2013<br />
09/01/2011 08/31/2013<br />
Tier 1<br />
09/14/2011<br />
08/31/2013<br />
Tier 1<br />
09/01/2011<br />
08/31/2013<br />
Tier 1<br />
09/01/2011<br />
08/31/2013<br />
Tier 1<br />
09/01/2011<br />
08/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/01/2011 08/31/2013
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