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 65 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2507<br />
COLUMBIA ST MARY'S BEHAVIORAL<br />
MEDICINE-MEQUON<br />
LAWRENCE MILLER<br />
13111 N PORT WASHINGTON ROAD<br />
MEQUON, WI 53097<br />
County: Ozaukee<br />
lmiller4@columbia-stmarys.org<br />
Phone: (262) 241-6127<br />
Fax: (262) 241-6132<br />
Surveyor: Mark Isaacs<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 />
09/02/2003<br />
03/01/2012<br />
02/28/2014<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment DHS 61.75<br />
1870<br />
COLUMBIA ST. MARY'S BEHAVIORAL MEDICINE -<br />
MILWAUKEE<br />
LAWRENCE MILLER<br />
2323 N LAKE DRIVE, 7TH FLOOR<br />
MILWAUKEE, WI 53211<br />
County: Milwaukee<br />
lmiller4@columbia-stmarys.org<br />
Phone: (414) 291-1620<br />
Fax: (414) 291-5969<br />
Surveyor: William Goehr<strong>in</strong>g<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 />
NO BRANCH LOCATIONS<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
06/01/1981<br />
01/01/2012<br />
12/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Day Treatment DHS 75.12<br />
CSAS-Medically Managed Inpatient Detox DHS 75.06<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment DHS 61.75<br />
1215<br />
COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE<br />
CAMPUS<br />
WILLIAM L. FRY<br />
2301 N LAKE DRIVE<br />
MILWAUKEE, WI 53211<br />
County: Milwaukee<br />
wfry@columbia-stmarys.org<br />
Phone: (414) 291-5520<br />
Fax: (414) 291-5521<br />
Surveyor: William Goehr<strong>in</strong>g<br />
Services<br />
NO BRANCH LOCATIONS<br />
03/01/2012 02/28/2014<br />
03/01/2012 02/28/2014<br />
03/01/2012 02/28/2014<br />
03/01/2012 02/28/2014<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
11/01/1982<br />
06/01/2012<br />
05/31/2014<br />
<strong>Mental</strong> <strong>Health</strong>-Inpatient DHS 61.71<br />
NO BRANCH LOCATIONS<br />
01/01/2012 12/31/2013<br />
01/01/2012 12/31/2013<br />
01/01/2012 12/31/2013<br />
01/01/2012 12/31/2013<br />
01/01/2012 12/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
06/01/2012 05/31/2014
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