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 270 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1826 SCHWERT AODA TREATMENT CENTER TODD VIETH 3501 KIPLING DRIVE MADISON, WI 53704 County: Dane tvieth@correctionalservices.org Phone: (608) 249-6226 Fax: (608) 249-1954 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 07/01/1992 07/01/2011 06/30/2013 CSAS-Transitional Residential DHS 75.14 2495 SEBASTIAN FAMILY PSYCHOLOGY PRACTICE, LLC SEBASTIAN SSEMPIJJA 1720 W FLORIST AVENUE, #125 MILWAUKEE, WI 53209 County: Milwaukee sseba4u@aol.com Phone: (414) 247-0801 Fax: (414) 247-0816 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 01/14/2004 03/01/2011 12/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2242 SHAWANO COUNTY DEPARTMENT OF COMMUNITY PROGRAMS COMMUNITY SUPPORT PROGRAM JOANN LISKA 504 LAKELAND ROAD SHAWANO, WI 54166 County: Shawano joann.liska@co.shawano.wi.us Phone: (715) 524-6888 Fax: (715) 526-5542 Surveyor: Frank Bellaire Services 07/01/2011 06/30/2013 SEBASTIAN FAMILY PSYCHOLOGY Tier 1 1501 SOUTH LAYTON BLVD 01/01/2012 MILWAUKEE, WI 53215 12/31/2012 SEBASTIAN FAMILY PSYCHOLOGY Tier 1 2463 NORTH BUFFUM STREET 01/01/2012 MILWAUKEE, WI 53212 12/31/2012 SEBASTIAN FAMILY PSYCHOLOGY Tier 1 3300 SOUTH 39TH STREET 01/01/2012 MILWAUKEE, WI 53215 12/31/2012 Administrative Code Chapter Service Begin/End Dates 01/01/2000 01/01/2011 12/31/2012 Mental Health-Community Support Program DHS 63 NO BRANCH LOCATIONS 03/01/2011 12/31/2012 03/01/2011 12/31/2012 Administrative Code Chapter Service Begin/End Dates 01/01/2011 12/31/2012
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 271 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1831 SHAWANO COUNTY DEPARTMENT OF COMMUNITY PROGRAMS JOANN LISKA 504 LAKELAND ROAD SHAWANO, WI 54166 County: Shawano joann.liska@co.shawano.wi.us Phone: (715) 524-6888 Fax: (715) 526-5542 Surveyor: Frank Bellaire Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 03/01/1977 01/01/2011 12/31/2012 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Emergency Outpatent with Telehealth DHS 75.05 CSAS-Emergency Outpatient DHS 75.05 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 Mental Health-Emergency Service 3 DHS 34.3 Mental Health-Emergency Service 3 w/Telehealth DHS 34.3 1832 SHAWANO MEDICAL CENTER PENNY BLOCK 309 N. BARTLETT STREET SHAWANO, WI 54166 County: Shawano pblock@shawanomed.org Phone: (715) 526-7210 Fax: (715) 526-7205 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 10/01/1978 04/01/2011 03/31/2013 CSAS-Medically Managed Inpatient Detox DHS 75.06 2315 SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP ERIC BRUNNICH 1011 N. 8TH STREET SHEBOYGAN, WI 53081 County: Sheboygan brunneb@co.sheboygan.wi.us Phone: (920) 459-3199 Fax: (920) 459-4353 Surveyor: Frank Bellaire Services NO BRANCH LOCATIONS 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 01/01/2011 12/31/2012 Administrative Code Chapter Service Begin/End Dates 07/01/1996 10/01/2011 09/30/2013 Mental Health-Community Support Program DHS 63 NO BRANCH LOCATIONS 04/01/2011 03/31/2013 Administrative Code Chapter Service Begin/End Dates 10/01/2011 09/30/2013
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