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 82 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2766 CRYSTAL LAKE COUNSELING LLC DEB SEVERSON 1821 ONE-1/2 STREET COMSTOCK, WI 54826 County: Barron crystallake@centurytel.net Phone: (715) 822-2980 Fax: (715) 822-2205 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 12/01/2007 12/01/2010 11/30/2012 Mental Health Outpatient Clinic DHS 35 2491 CURRENT INITIATIVES COUNSELING SERVICE LLC LASHAWNDA DAVIS 6815 WEST CAPITOL DR SUITE 207 MILWAUKEE, WI 53216 County: Milwaukee Cinitiatives@aol.com Phone: (414) 616-8805 Fax: (414) 616-2296 Surveyor: Demetrius Anderson 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 01/14/2004 01/01/2012 12/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Day Treatment DHS 75.12 CSAS-Outpatient Treatment DHS 75.13 2646 DANE COUNTY HUMAN SERVICES DEPT./JOURNEY MENTAL HEALTH CENTER LYNN A. BRADY 702 W MAIN STREET MADISON, WI 53703 County: Dane lynn.brady@journeymhc.org Phone: (608) 280-2561 Fax: (608) 280-2707 Surveyor: William Rohner Services NO BRANCH LOCATIONS 12/01/2010 11/30/2012 Administrative Code Chapter Service Begin/End Dates 03/01/2006 01/01/2012 02/28/2013 Mental Health-Emergency Service 3 DHS 34.3 NO BRANCH LOCATIONS 01/01/2012 12/31/2013 01/01/2012 12/31/2013 01/01/2012 12/31/2013 Administrative Code Chapter Service Begin/End Dates 01/01/2012 02/28/2013
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 83 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2940 DAY ONE - SILVER SPRING CENTER RONALD MENDYKE 5151 WEST SILVER SPRING DRIVE MILWAUKEE, WI 53218 County: Milwaukee rmendyke@phoenixcaresystems.com Phone: (414) 527-6940 Fax: (414) 527-6941 Surveyor: Demetrius Anderson Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 03/18/2011 03/01/2012 02/28/2014 Mental Health-Day Treatment DHS 61.75 2511 DEBORAH PETERMAN COUNSELING DEBORAH PETERMAN 1488 E GREEN BAY STREET, #8 SHAWANO, WI 54166 County: Shawano No Email Address Provided Phone: (715) 524-8896 Fax: (715) 524-8964 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 NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 03/24/2004 04/01/2008 03/31/2010 Mental Health-Outpatient DHS 61.91 1274 DELTA CENTER DAVID WILTZIUS 196 E. THIRD STREET FOND DU LAC, WI 54935 County: Fond Du Lac Wiltziusd@deltactr.com Phone: (920) 921-3343 Fax: (920) 921-0989 Surveyor: William Goehring Services NO BRANCH LOCATIONS 03/01/2012 02/28/2014 Administrative Code Chapter Service Begin/End Dates 01/18/1989 01/01/2011 12/31/2012 Mental Health Outpatient Clinic DHS 35 04/01/2008 03/31/2010 DELTA CENTER Tier 1 1080 W FOND DU LAC STREET 01/01/2011 RIPON, WI 54971 06/07/2011 Administrative Code Chapter Service Begin/End Dates 01/01/2011 12/31/2012
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Mental Health and Substance Abuse Programs in alphabetical

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