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 78 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
1250<br />
COUNSELING ASSOCIATES OF DOOR COUNTY,<br />
LLC<br />
WILLIAM G NICK<br />
620 N. 12TH AVENUE<br />
STURGEON BAY, WI 54235<br />
County: Door<br />
cadc@dcwis.com<br />
Phone: (920) 743-9554<br />
Fax: (920) 743-1591<br />
Surveyor: Frank Bellaire<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 />
11/16/1993<br />
06/01/2011<br />
11/30/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
2753<br />
COUNSELING CONNECTION OF MEDFORD<br />
KELLY SCHULTZ<br />
123 W STATE STREET, #4<br />
MEDFORD, WI 54451<br />
County: Taylor<br />
counsel<strong>in</strong>gconnection@tds.net<br />
Phone: (715) 748-4312<br />
Fax: (715) 748-4407<br />
Surveyor: Bradley Jahr<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 />
COUNSELING ASSOCIATES OF DOOR<br />
COUNTY<br />
3711 HWY 42<br />
FISH CREEK, WI 54212<br />
Tier 1<br />
06/01/2011<br />
11/30/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/01/2007<br />
11/01/2010<br />
08/31/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
2077<br />
COUNSELING SPECIALISTS, LLP<br />
BETH YOUNG-VERKUILEN<br />
424A E. LONGVIEW DRIVE<br />
APPLETON, WI 54911<br />
County: Outagamie<br />
<strong>in</strong>fo@counsel<strong>in</strong>g-specialist.com<br />
Phone: (920) 882-9877<br />
Fax: (920) 882-9880<br />
Surveyor: Frank Bellaire<br />
Services<br />
CADOTT MEDICAL<br />
CENTER-COUNSELING CONNECTION<br />
322 NORTH MAIN ST<br />
CADOTT, WI 54727<br />
06/01/2011 11/30/2012<br />
06/01/2011 11/30/2012<br />
Tier 1<br />
01/13/2012<br />
08/31/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/05/1998<br />
11/01/2010<br />
10/31/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
NO BRANCH LOCATIONS<br />
11/01/2010 08/31/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
11/01/2010 10/31/2012
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