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 296 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1918 THE PSYCHOLOGY CENTER, S.C. SUZANNE DRENNAN 7617 MINERAL POINT ROAD, #300 MADISON, WI 53717 County: Dane sdrennan@tpcmadison.com Phone: (608) 833-9290 Fax: (608) 833-9691 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 01/01/1989 12/01/2011 11/30/2013 Mental Health Outpatient Clinic DHS 35 1919 THE PSYCHOLOGY CLINIC, INC. JAMES BLACK, PHD 310 N. MIDVALE BOULEVARD, #202 MADISON, WI 53705 County: Dane jhblack@wisc.edu Phone: (608) 238-9991 Fax: (608) 238-1929 Surveyor: William Rohner 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 10/01/1991 11/01/2010 10/31/2012 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 1920 THE RAINBOW PROJECT, INC. SHARYL KATO 831 E. WASHINGTON AVENUE MADISON, WI 53703 County: Dane skato@therainbowproject.net Phone: (608) 255-7356 Fax: (608) 255-0457 Surveyor: William Rohner Services 12/01/2011 11/30/2013 AIDS NETWORK Tier 1 600 WILLIAMSON STREET 11/01/2010 MADISON, WI 53703 10/31/2012 THE PSYCHOLOGY CLINIC, INC - BARABOO Tier 2 701 ASH STREET 11/01/2010 BARABOO, WI 53913 10/31/2012 THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC Tier 2 1190 PRAIRIE STREET 11/01/2010 PRAIRIE DU SAC, WI 53578 10/31/2012 THE PSYCHOLOGY CLINIC, INC - WI DELLS Tier 1 1000 HWY 13 07/08/2011 WISCONSIN DELLS, WI 53965 10/31/2012 Administrative Code Chapter Service Begin/End Dates 05/01/1988 06/01/2011 05/31/2013 Mental Health Outpatient Clinic DHS 35 NO BRANCH LOCATIONS 11/01/2010 10/31/2012 11/01/2010 10/31/2012 Administrative Code Chapter Service Begin/End Dates 06/01/2011 05/31/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 297 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2805 THE REDI CLINIC - A DIVISION OF PATHWAY CLINIC, SC DAVID DRAJKOWSKI 2300 N MAYFAIR ROAD, #425 WAUWATOSA, WI 53226 County: Milwaukee ddrajkowski@pathwayclinic.com Phone: (414) 727-4455 Fax: (414) 727-4690 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 09/09/2008 10/01/2011 09/30/2013 Mental Health Outpatient Clinic DHS 35 Mental Health Outpatient Clinic with Telehealth DHS 35 Mental Health-Day Treatment DHS 61.75 1355 THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY ROSANGELA BERBERT 1478 KENWOOD DRIVE STE 1 MENASHA, WI 54952 County: Winnebago rberbert@samaritan-counseling.com Phone: (920) 886-9319 Fax: (920) 886-9357 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 THE REDI CLINIC - A DIVISION OF PATHWAY CLINIC 402 N GENESEE STREET DELAFIELD, WI 53018 Tier 2 10/01/2011 09/30/2013 Administrative Code Chapter Service Begin/End Dates 03/01/1983 03/01/2011 02/28/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 PROJECT OPEN DOOR IMMANUEL UNITED CHURCH 510 SULLIVAN AVENUE KAUKAUNA, WI 54130 THE SAMARITAN COUNSELING CTR FOX VALLEY 1478 MIDWAY ROAD MENASHA, WI 54952 THE SAMARITAN COUNSELING CTR FOX VALLEY 110 CHURCH AVENUE OSHKOSH, WI 54901 THE SAMARITAN COUNSELING CTR FOX VALLEY 709 W PINE STREET NEW LONDON, WI 54961 10/01/2011 09/30/2013 10/01/2011 09/30/2013 10/01/2011 09/30/2013 Tier 1 03/24/2011 02/28/2013 Tier 1 03/01/2011 02/28/2013 Tier 2 03/01/2011 02/28/2013 Tier 1 03/01/2011 02/28/2013 Administrative Code Chapter Service Begin/End Dates 03/01/2011 02/28/2013 03/01/2011 02/28/2013
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Mental Health and Substance Abuse Programs in alphabetical

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