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 81 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
1265<br />
CROSSROADS COUNSELING CENTER<br />
TIM PERRY<br />
17 S. RIVER STREET, #254<br />
JANESVILLE, WI 53548<br />
County: Rock<br />
tperry@crossroads73.com<br />
Phone: (608) 755-5260<br />
Fax: (608) 755-5267<br />
Surveyor: William Rohner<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 />
09/01/1977<br />
10/01/2011<br />
09/30/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment for Children 1 DHS 40.11(2)(a)<br />
2772<br />
CROSSROADS COUNSELING CENTER<br />
TIM PERRY<br />
1350 N PARKER DRIVE<br />
JANESVILLE, WI 53545<br />
County: Rock<br />
TPerryCrossroads@charter.net, mcefalu@crossroad<br />
Phone: (608) 208-6133<br />
Fax: (608) 755-5267<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 />
CROSSROADS COUNSELING CENTER Tier 1<br />
778 LOIS DRIVE<br />
10/01/2011<br />
SUN PRAIRIE, WI 53590<br />
09/30/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
02/06/2008<br />
02/01/2009<br />
01/31/2010<br />
<strong>Mental</strong> <strong>Health</strong>-Day Treatment for Children 1 DHS 40.11(2)(a)<br />
2219<br />
CROSSROADS COUNSELING SERVICES, LLC<br />
KAREN J. KOLTIS<br />
224 S. BROADWAY<br />
STANLEY, WI 54768<br />
County: Chippewa<br />
ccsllc@centurytel.net<br />
Phone: (715) 644-4357<br />
Fax: (715) 644-5053<br />
Surveyor: Bradley Jahr<br />
Services<br />
NO BRANCH LOCATIONS<br />
10/01/2011 09/30/2013<br />
10/01/2011 09/30/2013<br />
10/01/2011 09/30/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/01/2000<br />
09/01/2011<br />
09/30/2011<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
NO BRANCH LOCATIONS<br />
02/01/2009 01/31/2010<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/01/2011 09/30/2011<br />
09/01/2011 09/30/2011
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