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 63 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2701<br />
CLINIC FOR CHRISTIAN COUNSELING, LLC<br />
PHILIP KOESTLER<br />
505 S DEWEY, #208<br />
EAU CLAIRE, WI 54701<br />
County: Eau Claire<br />
ccc@cccwi.org<br />
Phone: (715) 832-1678<br />
Fax: (715) 832-6680<br />
Surveyor: Polly Wong<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 />
01/03/2007<br />
01/01/2012<br />
12/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
1206<br />
CLINICAL PSYCHOLOGY ASSOCIATES OF<br />
BURLINGTON<br />
DAVID W THOMPSON PHD<br />
345 MILWAUKEE AVENUE<br />
BURLINGTON, WI 53105<br />
County: Rac<strong>in</strong>e<br />
dthompson@cl<strong>in</strong>icpsych.com<br />
Phone: (262) 763-9191<br />
Fax: (262) 763-7767<br />
Surveyor: William Rohner<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 />
CLINIC FOR CHRISTIAN COUNSELING,<br />
LLC<br />
12 W MARSHALL STREET, #104<br />
RICE LAKE, WI 54868<br />
Tier 1<br />
01/01/2012<br />
12/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
03/01/1993<br />
04/01/2012<br />
03/31/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
1208<br />
CLINICAL SERVICES<br />
DR MICHAEL J NELSON<br />
420 - 1ST AVENUE SOUTH<br />
WISCONSIN RAPIDS, WI 54495<br />
County: Wood<br />
No Email Address Provided<br />
Phone: (715) 424-3400<br />
Fax: (715) 424-3441<br />
Surveyor: Bradley Jahr<br />
Services<br />
CLINICAL PSYCHOLOGY ASSOC OF<br />
WATERFORD<br />
207B MILWAUKEE AVENUE<br />
WATERFORD, WI 53185<br />
01/01/2012 12/31/2013<br />
Tier 1<br />
04/01/2012<br />
03/31/2014<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/01/1988<br />
10/01/2011<br />
09/30/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
NO BRANCH LOCATIONS<br />
04/01/2012 03/31/2014<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/01/2011 09/30/2013
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