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 274 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2501 SHORE COUNSELING AND CONSULTING CLINIC THOMAS TROAST 2600 N MAYFAIR ROAD, #650 WAUWATOSA, WI 53226 County: Milwaukee drtroast@wi.rr.com Phone: (414) 771-9304 Fax: (414) 771-9543 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 11/24/2003 02/01/2011 11/30/2012 Mental Health Outpatient Clinic DHS 35 1836 SHOREHAVEN BEHAVIORAL HEALTH, INC LYNN GODEC 3900 W. BROWN DEER ROAD, #200 GLENDALE, WI 53209 County: Milwaukee lgodec@shorehavenbhi.com Phone: (414) 540-2170 Fax: (414) 540-2171 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 SHORE COUNSELING AND CONSULTING CLINIC 6110 N PORT WASHINGTON ROAD GLENDALE, WI 53217 Tier 1 02/01/2011 11/30/2012 Administrative Code Chapter Service Begin/End Dates 07/01/1983 07/01/2012 12/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 1838 SILVER SPRING PSYCHOTHERAPY ASSOCIATES MARY ANN MITCHELL 5215 N IRONWOOD ROAD, #115 MILWAUKEE, WI 53217 County: Milwaukee mitchellsspa@gmail.com Phone: (262) 821-7027 Fax: (414) 332-0855 Surveyor: William Goehring Services SHOREHAVEN BEHAVIORAL HEALTH, INC 8405 W FOREST HOME, #104 GREENFIELD, WI 53228 02/01/2011 11/30/2012 Tier 2 07/01/2012 12/31/2012 Administrative Code Chapter Service Begin/End Dates 05/01/1993 05/01/2012 04/30/2014 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 07/01/2012 12/31/2012 07/01/2012 12/31/2012 07/01/2012 12/31/2012 Administrative Code Chapter Service Begin/End Dates 05/01/2012 04/30/2014
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 275 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2506 SOAR COUNSELING SERVICES CHERI KREITZMANN 246 INDUSTRIAL DRIVE SHELL LAKE, WI 54871 County: Washburn kreitzmannco@gmail.com Phone: (307) 250-1338 Fax: (715) 468-2374 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 03/11/2004 04/01/2012 03/31/2014 Mental Health Outpatient Clinic DHS 35 2373 SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM PRISCILLA WALLACE 4041 N. RICHARDS STREET MILWAUKEE, WI 53212 County: Milwaukee Pwallace@cr-sdc.org Phone: (414) 906-2711 Fax: (414) 963-2691 Surveyor: Demetrius Anderson Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates SOAR COUNSELING SERVICES Tier 2 517 BEASER AVENUE 04/01/2012 ASHLAND, WI 54806 03/31/2014 Administrative Code Chapter Service Begin/End Dates 04/29/2002 05/01/2012 04/30/2014 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 2194 SOKAOGON CHIPPEWA HEALTH CLINIC PAULETTE SMITH 3144 VAN ZILE ROAD CRANDON, WI 54520 County: Forest wgc567@yahoo.com Phone: (715) 478-5180 Fax: (715) 478-5904 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 04/01/2012 03/31/2014 Administrative Code Chapter Service Begin/End Dates 02/28/2000 01/01/2012 12/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 05/01/2012 04/30/2014 05/01/2012 04/30/2014 Administrative Code Chapter Service Begin/End Dates 01/01/2012 12/31/2012 01/01/2012 12/31/2012
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