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 286 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1881 STILLWATER COUNSELING CENTER HELEN PONEC 933 N MAYFAIR ROAD, #303 WAUWATOSA, WI 53226 County: Milwaukee No Email Address Provided Phone: (414) 456-9929 Fax: (414) 456-9994 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 02/01/1996 02/01/2010 01/31/2011 Mental Health Outpatient Clinic DHS 35 1882 STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER LYDIA VITORIT W12802 COUNTY ROAD A BOWLER, WI 54416 County: Shawano lydia.vitorit@mohican.com Phone: (715) 793-3000 Fax: (715) 793-1312 Surveyor: Frank Bellaire 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 12/01/1984 05/01/2011 04/30/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 CSAS-Outpatient Treatment DHS 75.13 CSAS-Outpatient Treatment with Telehealth DHS 75.13 1883 STOUGHTON FAMILY COUNSELING SERVICES LLC PATRICIA RENAULT 1520 VERNON STREET STOUGHTON, WI 53589 County: Dane sfcs01@gmail.com Phone: (608) 873-6422 Fax: (608) 873-6014 Surveyor: William Rohner Services NO BRANCH LOCATIONS 02/01/2010 01/31/2011 Administrative Code Chapter Service Begin/End Dates 06/01/1980 11/01/2011 10/31/2013 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 05/01/2011 04/30/2013 Administrative Code Chapter Service Begin/End Dates 11/01/2011 10/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 287 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1884 STOUGHTON HOSPITAL HEATHER KLEINBROOK 900 RIDGE STREET STOUGHTON, WI 53589 County: Dane hkleinbrook@stohosp.com Phone: (608) 873-2242 Fax: (608) 873-2339 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 09/01/1997 09/01/2012 08/31/2014 CSAS-Medically Managed Inpatient Detox DHS 75.06 Mental Health-Inpatient DHS 61.71 1887 STRESS MANAGEMENT & MENTAL HEALTH CLINICS, INC. PAUL GLASS 2717 N. GRANDVIEW BLVD., #303 WAUKESHA, WI 53188 County: Waukesha waukesha@stressmanagementclinic.com Phone: (262) 544-6486 Fax: (262) 544-6377 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 10/01/1990 10/01/2010 09/30/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1886 STRESS MANAGEMENT & MENTAL HEALTH CLINICS DR CRAIG MODELL 5225 N. IRONWOOD LANE, #102 GLENDALE, WI 53217 County: Milwaukee No Email Address Provided Phone: (414) 329-7000 Fax: (414) 329-7010 Surveyor: Demetrius Anderson Services NO BRANCH LOCATIONS 09/01/2012 08/31/2014 09/01/2012 08/31/2014 Administrative Code Chapter Service Begin/End Dates 10/01/1997 04/01/2012 03/31/2014 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 10/01/2010 09/30/2012 10/01/2010 09/30/2012 Administrative Code Chapter Service Begin/End Dates 04/01/2012 03/31/2014
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Mental Health and Substance Abuse Programs in alphabetical

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