Community Mental Health Program Certification Directory By County, City, and Provider Name Adams County

Transcription

1 DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Community Mental Health Program Certification Directory By County, City, and Provider Name Adams County STATE OF WISCONSIN Bureau of Health Services PO Box 969 Madison, WI ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: E NORTH STREET FRIENDSHIP, WI 594 Adams County DIANE CABLE Initial Cert: 1/10/008 [email protected] Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Lic #: E NORTH STREET FRIENDSHIP, WI 594 Adams County DIANE CABLE Initial Cert: 09/01/1990 [email protected] Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 11/4/015 Page 1 of 186

2 Ashland County ASHLAND COUNTY HEALTH AND HUMAN SERVICES/NORTHLAND COUNSELING SERVICES Lic #: WEST THIRD STREET ASHLAND, WI Ashland County Surveyor: Polly Wong TERRI PERRY Initial Cert: 01/6/006 Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 04/01/015 0/1/017 04/01/015 0/1/017 BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER Lic #: MAPLE LANE ASHLAND, WI Ashland County Surveyor: Polly Wong CONNIE GUDERIAN Initial Cert: 10/01/1999 Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI /01/015 09/0/017 DRUMMOND AREA SCHOOL DISTRICT, 5440 EASTERN AVE, DRUMMOND, WI /01/015 09/0/017 NORTHLAND COLLEGE, 1411 ELLIS AVE, ASHLAND, WI /05/016 09/0/017 NEW HORIZONS NORTH CCS - ASHLAND COUNTY Lic #: WEST MAIN STREET ASHLAND, WI Ashland County VALERIE LEVNO [email protected] Phone: (715) Fax: Initial Cert: 01/01/015 NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM Lic #: W MAIN STREET ASHLAND, WI Ashland County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 05/1/1991 [email protected] Phone: (715) /01/015 11/0/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page of 186

3 Barron County BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 640 EAST MONROE AVE ROOM 8 BARRON, WI 5481 Barron County Surveyor: Polly Wong DAVID HENSLEY Initial Cert: 01/01/006 [email protected] Phone: (715) /01/015 10/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 11/01/015 10/1/017 BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: E. EAU CLAIRE STREET RICE LAKE, WI Barron County Surveyor: Polly Wong DAVID HENSLEY Initial Cert: 11/01/010 [email protected] Phone: (715) /01/015 10/1/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 MARRIAGE AND FAMILY HEALTH SERVICES, LTD Lic #: WEST AVENUE RICE LAKE, WI Barron County Surveyor: Polly Wong DR. TOM JOHNSTON Initial Cert: 0/01/007 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/014 01/1/016 11/4/015 Page of 186

4 Bayfield County NORTHLAKES COMMUNITY CLINIC - AODA SERVICES Lic #: US HWY IRON RIVER, WI Bayfield County Surveyor: Polly Wong JASON AKL Initial Cert: 09/01/1984 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINC-ASHLAND DENTAL CLINIC, 719 MAIN STREET EAST, ASHLAND, WI 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC - WASHBURN, 101 THOMPSON ROAD, WASHBURN, WI /01/015 08/1/016 NORTHLAKES COMMUNITY CLINIC-ASHLAND AODA CLINIC, 50 W MAIN ST, SUITE 05, ASHLAND, WI 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC-HAYWARD DENTAL CLINIC, 15910W COMPANY LAKE RD, HAYWAR 10/01/014 01/18/015 NORTHLAKES COMMUNITY CLINIC-HAYWARD MEDICAL CLINIC, 1118N STATE HIGHWAY 77, HAYWAR 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC-MINONG MEDICAL CLINIC, 600 SHELL CREEK ROAD, MINONG, WI 10/01/014 08/1/016 ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI BAD RIVER HEAD START, 5759 PINE STREET, ODANAH, WI LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI /01/015 08/1/016 10/01/015 08/1/016 10/01/015 08/1/016 10/01/015 08/1/016 NEW HORIZONS NORTH CCS - BAYFIELD COUNTY Lic #: WEST BAYFIELD STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong VAL LEVNO Initial Cert: 01/01/015 [email protected] Phone: (715) /01/015 1/1/015 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 01/01/015 1/1/015 NEW HORIZONS NORTH DBA CALM WATERS WELLNESS Lic #: 05 4 WEST BAYFIELD STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 07/01/014 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) CALM WATERS WELLNESS, NORTH FIRST ST, BAYFIELD, WI NEW HORIZONS NORTH DBA CALM WATERS WELLNESS, 1001 W MAIN STREET, ASHLAND, WI /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI ASHLAND MIDDLE SCHOOL, 0 11TH STREET EAST, ASHLAND, WI BAYFIELD ELM/MIDDLE & HIGH SCHOOL, 00 NORTH 4TH STREET, BAYFIELD, WI LAKE SUPERIOR PRIMARY & INTERMEDIATE SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI RED CLIFF EARLY CHILDHOOD CENTER, 8980 TINY TOT DRIVE, BAYFIELD, WI WASHBURN ELM/MIDDLE SCHOOL, 411 WEST 8TH STREET, WASHBURN, WI /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 09/01/015 07/01/015 06/0/017 11/4/015 Page 4 of 186

5 NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM Lic #: W BAYFIELD STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 0/01/1991 [email protected] Phone: (715) /01/015 11/0/017 Fax: (715) 7-0 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 NORTHLAND COUNSELING SERVICES 1 W OMAHA STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong Lic #: 61 JEREMY KOEHL Initial Cert: 07/01/001 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI /01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI /01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI /01/014 06/0/016 11/4/015 Page 5 of 186

6 Brown County SPECTRUM BEHAVIORAL HEALTH LLC 1496 BELLEVUE STREET, SUITE 101 BELLEVUE, WI 5411 Brown County Lic #: 076 KC CARMODY Initial Cert: 01/0/015 Phone: (90) /0/015 01/1/016 Fax: (90) /0/015 01/1/016 AURORA BEHAVIORAL HEALTH CENTER 1881 CHICAGO STREET DE PERE, WI Brown County Lic #: 76 MELISA VANDE HEI Initial Cert: 06/08/007 Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 EMPLOYEE RESOURCE CENTER, INC WEST MAIN AVE SUITE 100 DE PERE, WI Brown County Lic #: 101 JAMES PECARD III Initial Cert: 07/01/1989 Phone: (90) /01/014 07/1/016 Fax: (90) /01/014 07/1/016 LIVING HOPE CHRISTIAN COUNSELING 066 LAWRENCE DRIVE DE PERE, WI Brown County Lic #: 597 JOHN C JOHNSON Initial Cert: 08/1/005 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) /01/014 08/1/016 NORTHWEST JOURNEY - GREEN BAY 00 S SIXTH ST, LOWER LEVEL DE PERE, WI Brown County Lic #: 160 JENNIFER SOVEY-FAHEY Initial Cert: 11/01/1999 [email protected] Phone: (90) /01/015 10/1/017 Fax: (90) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 11/01/015 10/1/017 11/01/015 10/1/017 11/4/015 Page 6 of 186

7 RIVERSIDE PSYCHIATRIC GROUP SC 15 ANGELS PATH DE PERE, WI Brown County Lic #: 64 DINA BRAUN Initial Cert: 1/01/000 Phone: (90) /01/015 1/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/016 01/01/015 1/1/016 WISCONSIN EARLY AUTISM PROJECT, INC W. MAIN AVE #01 DE PERE, WI Brown County Lic #: 460 KIM SCHUTT-CHARDON Initial Cert: 04/01/00 Phone: (608) /01/015 0/1/016 Fax: (608) /01/015 0/1/016 AMERICAN FOUNDATION OF COUNSELING SERVICES, INC. Lic #: E WALNUT STREET #706 GREEN BAY, WI 5401 Brown County JILL BECK Initial Cert: 04/01/1981 [email protected] Phone: (90) /01/014 04/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 1 GOLDEN HOUSE, 110 UNIVERSITY AVE, GREEN BAY, WI /01/014 04/0/016 1 HOUSE OF HOPE, 1660 CHRISTIANA ST., GREEN BAY, WI /01/014 04/0/016 1 MICAH CENTER, 700 E. WALNUT ST., GREEN BAY, WI /01/015 04/0/016 1 NEW COMMUNITY CLINIC - NWTC, 740 W. MASON ST., GREEN BAY, WI /1/015 04/0/016 1 NEW COMMUNITY CLINIC, 6 BODART ST, GREEN BAY, WI /1/015 04/0/016 1 OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI /01/015 04/0/016 NEW COMMUNITY SHELTER, 01 MATHER ST, GREEN BAY, WI /01/015 04/0/016 BAETEN COUNSELING & CONSULTATION TEAM, S.C Lic #: S WEBSTER AVE, SUITE B GREEN BAY, WI 5401 Brown County TINA BAETEN Initial Cert: 08/06/014 [email protected] Phone: (90) /01/015 07/1/017 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 11/4/015 Page 7 of 186

8 BELLIN PSYCHIATRIC CENTE BELLEVUE 6 EATON ROAD GREEN BAY, WI 5411 Brown County Lic #: 44 STEVE DUSCHER Initial Cert: 10/10/00 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) /01/014 10/1/016 BELLIN PSYCHIATRIC CENTER-MANITOWOC, 415 CUSTER ST SUITE D, MANITOWOC, WI /01/014 10/1/016 BELLIN PSYCHIATRIC CENTER 01 E ST JOSEPH STREET GREEN BAY, WI 5405 Brown County Lic #: 1098 STEVE DUSCHER Initial Cert: 04/01/1984 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) 41-0 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 0/1/015 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - ALGOMA, 81 PARKER ST, ALGOMA, WI /04/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - BRILLION, 964 W. RYAN ST., STE. B, BRILLION, WI /0/015 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 575-4TH ST, KEWAUNEE, WI /01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 704 S. WEBSTER STE. #01, GREEN BAY, WI /01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI /01/014 0/1/016 BELLIN PSYCHIATRIC CENTER - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI BELLIN PSYCHIATRIC CENTER - OCONTO FALLS, 8 MAIN STREET, OCONTOFALLS, WI BELLIN PSYCHIATRIC CENTER-NEURO TEAM, 75 S WEBSTER, GREEN BAY, WI 5405 BELLIN PSYCHIATRIC CENTER-W. DE PERE, 1800 LAWRENCE DR, DE PERE, WI DR. ROSA MINOKA-HILL SCHOOL, 5 N ROOSEVELT, GREEN BAY, WI /0/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 1/04/014 0/1/016 BELLIN PSYCHIATRIC CENTER BEHAVIORAL HEALTH CLINIC ASHWAUBENON Lic #: COMMANCHE AVENUE GREEN BAY, WI 541 Brown County STEVE DUSCHER Initial Cert: 06/0/000 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 1 BELLIN PSYCHIATRIC CENTER-ONCOLOGY, 1580 COMMANCHE AVENUE, GREEN BAY, WI /01/014 06/0/016 1 BELLIN PSYCHIATRIC CENTER-UNITED HEALTHCARE, 100 AMS BLVD, GREEN BAY, WI /01/014 06/0/016 11/4/015 Page 8 of 186

9 BROWN COUNTY COMMUNITY TREATMENT CENTER Lic #: GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 10/01/1975 Phone: (90) /01/015 08/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. MENTAL HEALTH-INPATIENT DHS /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI /01/015 08/1/017 BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 08/5/005 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/014 08/1/016 09/01/014 08/1/016 BROWN COUNTY HUMAN SERVICES-CSP BROWN COUNTY COMMUNITY TREATMENT CENTER Lic #: GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 06/4/00 [email protected] Phone: (90) /01/015 08/1/017 Fax: (90) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 09/01/015 08/1/017 09/01/015 08/1/017 CATHOLIC CHARITIES, DIOCESE OF GREEN BAY, INC. Lic #: RIVERSIDE DRIVE GREEN BAY, WI 5405 Brown County CELIA J. LATOUR Initial Cert: 01/01/1988 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) /01/015 01/1/017 CATHOLIC CHARITIES OF GREEN BAY, 844 PIERCE AVENUE, SUITE 00, MARINETTE, WI /01/015 01/1/017 11/4/015 Page 9 of 186

10 FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: CROOKS STREET GREEN BAY, WI 5401 Brown County LOIS MISCHLER Initial Cert: 01/1/1996 Phone: (90) /01/014 0/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 1 BILLIE KRESS CENTER - YOUTH DEVELOPMENT, 40 SPIRIT WAY, GREEN BAY, WI /01/014 0/1/016 1 FAMILY SERVICES - SOUTH IRWIN, 66 S IRWIN AVENUE, GREEN BAY, WI /0/014 0/1/016 1 WILLOW TREE, 50 S MONROE STREET, GREEN BAY, WI /0/014 0/1/016 DR. ROSA MINOKA-HILL SCHOOL, 5 N. ROOSEVELT, GREEN BAY, WI 5401 GREEN BAY ALTERNATIVE SCHOOL, 00 SOUTH BROADWAY ST., GREEN BAY, WI 540 0/04/015 0/1/016 0/04/015 0/04/015 FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: 1 66 S. IRWIN AVENUE GREEN BAY, WI 5401 Brown County JODY GREENWELL Initial Cert: 0/01/1984 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) 4-8 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 04/01/015 0/1/017 INDEPENDENT ASSESSMENT & COUNSELING SERVICES Lic #: W MASON STREET, #01 GREEN BAY, WI 540 Brown County KENNETH SANN Initial Cert: 06//001 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 INNOVATIVE COUNSELING, INC SIXTH STREET GREEN BAY, WI 5404 Brown County Lic #: 8 CINDY HALFORD Initial Cert: 1/14/000 cindyhalford@innovativecounseling. Phone: (90) /01/015 1/1/016 Fax: (90) /01/015 1/1/016 1 INNOVATIVE COUNSELING, INC., 7488 SPRUCE STREET, MINOCQUA, WI /0/016 1/1/016 11/4/015 Page 10 of 186

11 KA'NI KUHLI'YO FAMILY CENTER 640 WEST POINT ROAD GREEN BAY, WI 540 Brown County Lic #: 1454 MARI KRIESCHER Initial Cert: 0/11/199 Phone: (90) /01/015 01/1/017 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 01/1/017 0/01/015 01/1/017 1 ONEIDA COMMUNITY HEALTH CENTER, 55 AIRPORT DRIVE, ONEIDA, WI /01/015 01/1/017 1 ONEIDA NATION VETERAN'S DEPARTMENT, 14 RIVERDALE DR., ONEIDA, WI /01/015 01/1/017 ONEIDA NATION ELEMENTARY SCHOOL, N715 SEMINARY ROAD, ONEIDA, WI ONEIDA NATION HIGH SCHOOL, N710 SEMINARY ROAD, ONEIDA, WI /01/015 01/1/017 0/01/015 01/1/017 KIMBERLEY WELK AND ASSOCIATES LLC 10 EAST WALNUT STREET STE #607 GREEN BAY, WI 5401 Brown County Lic #: 05 KIMBERLEY WELK Initial Cert: 04/11/014 [email protected] Phone: (90) /01/015 0/1/016 Fax: (888) /01/015 0/1/016 NEW WELLNESS ASSOCIATES, INC. 7 S. RIDGE ROAD GREEN BAY, WI 5404 Brown County Lic #: 1669 PATTY HOWARD Initial Cert: 06/01/199 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 05/1/016 06/01/014 05/1/016 1 NEW WELLNESS ASSOCIATES INC, 40 CROOKS AVENUE, KAUKAUNA, WI /01/014 05/1/016 POWER FOR CHANGE, LLC 109 W MASON STREET GREEN BAY, WI 540 Brown County Lic #: 99 STEVE SHEFCHIK Initial Cert: 10/1/010 [email protected] Phone: (90) /01/015 10/1/017 Fax: (888) /01/015 10/1/017 11/4/015 Page 11 of 186

12 ST. VINCENT HOSPITAL DBA PREVEA HEALTH 680 VERNON DRIVE GREEN BAY, WI 5404 Brown County Lic #: 174 JEFFREY STUMBRAS Initial Cert: 1/09/1996 Phone: (90) /01/014 1/1/015 Fax: (90) /01/014 1/1/015 1 LENA PRIMARY CARE CLINIC, 00 S ROSERA STREET, LENA, WI /01/014 1/04/014 1 PREVEA CLINIC BEHAVIORAL CARE, 1715 DOUSMAN ST, GREEN BAY, WI 540 0/01/014 1/1/015 1 PREVEA CLINIC BEHAVIORAL CARE, 177 SHAWANO AVENUE, GREEN BAY, WI 540 0/01/014 1/1/015 1 PREVEA CLINIC BEHAVIORAL CARE, 181 WEBSTER AVE, GREEN BAY, WI /01/014 1/1/015 1 PREVEA CLINIC BEHAVIORAL CARE, 79 LINEVILLE ROAD, GREEN BAY, WI 541 0/01/014 1/1/015 1 PREVEA CLINIC BEHAVIORAL CARE, 01 VOYAGER DRIVE, GREEN BAY, WI /01/014 1/1/015 1 PREVEA EAST DEPERE HEALTH CENTER, 860 MONROE ROAD, DE PERE, WI /01/014 1/1/015 1 PREVEA OCONTO FALLS, 85 MAIN STREET, OCONTO FALLS, WI /04/014 1/1/015 1 PREVEA OCONTO HEALTH CENTER, 60 SMITH STREET, OCONTO, WI /01/014 1/1/015 1 PREVEA PULASKI HEALTH CENTER, 940 S AUGUSTINE STREET, PULASKI, WI /01/014 1/1/015 VILLA HOPE COMMUNITY SUPPORT PROGRAM OF BROWN COUNTY Lic #: GUNS ROAD GREEN BAY, WI 5411 Brown County MOLLIE TOONEN Initial Cert: 0/06/1996 [email protected] Phone: (90) /01/014 0/9/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/014 0/9/016 Buffalo County CATALYST FOR CHANGE CONSULTANTS, LLP 17 SOUTH ND STREET ALMA, WI Buffalo County Surveyor: Roderic Senn Lic #: 887 DONNA JULEFF Initial Cert: 11/4/009 [email protected] Phone: (715) /01/015 10/1/016 Fax: (715) CATALYST FOR CHANGE CONSULTANTS, BLAIR STREET, WHITEHALL, WI /01/015 10/1/016 11/01/015 10/1/016 11/4/015 Page 1 of 186

13 Burnett County ACCESS INC COMMUNITY SUPPORT PROGRAM Lic #: STATE ROAD 70/5 UNIT D SIREN, WI 5487 Burnett County Surveyor: Polly Wong ANDREW WOLF Initial Cert: 01/01/006 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/6/015 1/1/016 01/01/015 1/1/016 BURNETT COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT/ACCESS, INC Lic #: COUNTY K, #80 SIREN, WI 5487 Burnett County Surveyor: Polly Wong BYRON HOPKE Initial Cert: 1/01/005 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 FAMILIES FIRST COUNSELING, LLC 758 STATE ROAD 5 SIREN, WI 5487 Burnett County Surveyor: Polly Wong Lic #: 49 CATHERINE HAYMAN Initial Cert: 01/08/004 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) /01/015 01/1/017 1 FAMILIES FIRST COUNSELING CENTER, LLC, 809 US HWY 8, ST CROIX FALLS, WI /01/015 01/1/017 NORTHWEST JOURNEY - SIREN 7670 JOHNSON STREET SIREN, WI 5487 Burnett County Surveyor: Polly Wong Lic #: 90 CURTIS EMERSON Initial Cert: 0/1/001 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 04/01/014 0/1/016 04/01/014 0/1/016 11/4/015 Page 1 of 186

14 ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC Lic #: STATE RD 70 WEBSTER, WI 5489 Burnett County Surveyor: Polly Wong SARAH CORMELL Initial Cert: 05/01/000 Phone: (715) /01/014 04/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 1 ROUND LAKE CLINIC, 0-60TH AVENUE, LUCK, WI /01/014 04/0/016 Calumet County CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 CALUMET COUNTY DEPT OF HUMAN SERVICES, 06 S. ONEIDA STREET, APPLETON, WI /01/014 06/0/016 CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 07/01/000 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 07/01/014 06/0/016 CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 06/1/006 [email protected] Phone: (90) /01/015 06/0/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 Page 14 of 186

15 Chippewa County MARRIAGE & FAMILY HEALTH SERVICES, LTD. 405 ISLAND STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn Lic #: 44 THOMAS JOHNSTON Initial Cert: 01/01/00 Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 05/01/014 04/0/016 ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Lic #: COUNTY HIGHWAY I CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn THERESA MACKEY Initial Cert: 01/1/1977 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM Lic #: N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 05/01/015 [email protected] Phone: (715) /01/015 04/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 05/01/015 04/0/016 05/01/015 04/0/016 1 BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI /01/015 04/0/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI /01/015 04/0/016 WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM - CSP Lic #: N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 05/01/015 [email protected] Phone: (715) /01/015 04/0/016 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/016 05/01/015 04/0/016 1 BUFFALO COUNTY DEPT OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI /01/015 04/0/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI /01/015 04/0/016 11/4/015 Page 15 of 186

16 WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS Lic #: N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 04/01/015 [email protected] Phone: (715) /01/015 0/1/016 Fax: (715) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 6 04/01/015 0/1/016 04/01/015 0/1/016 1 BUFFALO COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI /01/015 0/1/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI /01/015 0/1/016 1 RUSK COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 11 E. MINER STREET, LADYSMITH, WI /01/015 0/1/016 BARRON COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 5 E. MONROE AVE., BARRON, WI 5481 DUNN COUNTY DEPT OF HUMAN SERVICES, 001 US HWY 1 E., STE. 160, MENOMONIE, WI DUNN COUNTY DEPT OF HUMAN SERVICES, 808 MAIN STREET, MENOMONIE, WI PIERCE COUNTY DEPT OF HUMAN SERVICES, 41 W. KINNE STREET, ELLSWORTH, WI POLK COUNTY HUMAN SERVICES DEPARTMENT, 100 POLK COUNTY PLAZA, SUITE 50, BALSAM LAKE 04/01/015 0/1/016 04/1/015 0/1/016 04/01/015 04/1/015 04/01/015 0/1/016 04/01/015 0/1/016 Chisago County (MN) 11/4/015 Page 16 of 186

17 Clark County CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET RM 50 NEILLSVILLE, WI Clark County Surveyor: Roderic Senn Lic #: 101 SUE VOIGT Initial Cert: 01/01/1984 Phone: (715) /01/014 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 CLARK COUNTY HEALTH CARE CENTER, W466 STATE HWY 9, OWEN, WI /01/014 1/1/015 GRANTON SCHOOL DISTRICT, 17 N. MAIN STREET, GRANTON, WI 5446 LOYAL SCHOOL DISTRICT, 514 WEST CENTRAL STREET, LOYAL, WI NEILLSVILLE ELEMENTARY SCHOOL, 405 EAST 5TH STREET, NEILLSVILLE, WI NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI /10/015 1/1/015 11/16/016 1/1/015 01/7/015 1/1/015 01/7/015 1/1/015 CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET, ROOM 50 NEILLSVILLE, WI Clark County Surveyor: Roderic Senn Lic #: 09 SUE VOIGT Initial Cert: 09/01/015 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/015 08/1/016 09/01/015 08/1/016 CLARK COUNTY COMMUNITY SUPPORT PROGRAM Lic #: COURT ST, ROOM 50 NEILLSVILLE, WI Clark County Surveyor: Roderic Senn RUSSELL GIRARD Initial Cert: 04/01/1991 [email protected] Phone: (715) /01/01 11/0/015 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/01 11/0/015 1/01/01 11/0/015 11/4/015 Page 17 of 186

18 Columbia County ASPEN FAMILY COUNSELING 69 NEW PINERY ROAD, #1 PORTAGE, WI 5901 Columbia County Lic #: 1066 BARRY ERATH Initial Cert: 01/01/015 Phone: (608) /01/015 1/1/015 Fax: (608) /01/015 1/1/015 CAMBRIA FRIELAND SCHOOL, 410 E. EDGEWATER ST., CAMBRIA, WI 59 10/9/015 1/1/015 PARDEEVILLE MIDDLE AND HIGH SCHOOL, 10 OAK STREET, PARDEEVILLE, WI /9/015 1/1/015 COLUMBIA COUNTY COMMUNITY SUPPORT PROGRAM Lic #: HUNTERS TRAIL PORTAGE, WI 5901 Columbia County PAMELA J POLZER Initial Cert: 1/01/1997 [email protected] Phone: (608) /01/015 11/0/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: MURPHY ROAD PORTAGE, WI 5901 Columbia County DAWN WOODARD Initial Cert: 04/01/010 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 COLUMBIA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: MURPHY ROAD PORTAGE, WI 5901 Columbia County DAWN WOODARD Initial Cert: 07/01/006 [email protected] Phone: (608) /01/015 10/1/017 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 11/4/015 Page 18 of 186

19 COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS Lic #: HUNTERS TRAIL PORTAGE, WI 5901 Columbia County DR. JOCELYN MILLER PHD Initial Cert: 10/08/1999 Phone: (608) /01/015 06/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/016 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 100 LINCOLN AVE, BARABOO, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 19 PARK AVENUE, COLUMBUS, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 95 US HIGHWAY 14 WEST, RICHLAND CENTER, 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 50 PRAIRIE AVE, PRAIRIE DU SAC, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 710 NORTH WEBB AVE STE 400, REEDSBURG, WI 07/01/015 06/0/016 COMPASS COUNSELING 910 NEW PINERY ROAD UNIT A PORTAGE, WI 5901 Columbia County Lic #: 905 SARAH KRAVICK Initial Cert: 05/01/010 [email protected] Phone: (608) /01/015 04/0/017 Fax: (608) /01/015 04/0/017 TRANSITIONS BEHAVIORAL HEALTH LLC 17 DE WITT ST PORTAGE, WI 5901 Columbia County Lic #: 915 JESSICA BECKETT Initial Cert: 07/01/010 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) /01/015 06/0/017 11/4/015 Page 19 of 186

20 Crawford County CRAWFORD COUNTY COMMUNITY SUPPORT PROGRAM Lic #: 76 5 N BEAUMONT ROAD #6 PRAIRIE DU CHIEN, WI 581 Crawford County Surveyor: Cynthia Lindgren DANIEL MCWILLIAMS Initial Cert: 05/01/00 [email protected] Phone: (608) /01/014 0/1/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/014 0/1/016 CRAWFORD COUNTY HUMAN SERVICES DEPARTMENT Lic #: N BEAUMONT ROAD #6 PRAIRIE DU CHIEN, WI 581 Crawford County Surveyor: Cynthia Lindgren DANIEL MCWILLIAMS Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 0/1/016 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 04/01/014 0/1/016 04/01/014 0/1/016 11/4/015 Page 0 of 186

21 Dane County FOUNDATIONS COUNSELING CENTER, LLC 619 RIVER STREET BELLEVILLE, WI 5508 Dane County Surveyor: William Rohner Lic #: 508 ALISA KELLY-MARTINA Initial Cert: 04/01/004 Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 ARC COMMUNITY SERVICES, INC. MADISON 1409 EMIL STREET, #100 MADISON, WI 571 Dane County Lic #: 105 LAURA FABICK Initial Cert: 0/01/1995 Phone: (608) /01/015 0/8/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 1 DAY REPORTING CENTER, 7017 RAYWOOD ROAD, MADISON, WI 571 0/01/015 0/8/017 1 SUMMIT CREDIT UNION COMMUNITY ROOM, 1 W MAIN STREET, SUN PRAIRIE, WI /01/015 0/8/017 CATHOLIC CHARITIES, INC., CENTRAL CITY COUNSELING SERVICES Lic #: SOUTH PARK ST SUITE 00 MADISON, WI 571 Dane County JERILYN ROBINSON Initial Cert: 01/01/1979 [email protected] Phone: (608) /01/014 04/0/016 Fax: (608) /01/014 04/0/016 1 CATHOLIC CHARITIES, BELOIT OFFICE, SHOPIERE ROAD, BELOIT, WI /01/014 01/01/015 1 CATHOLIC CHARITIES, JANESVILLE OFFICE, 00 E MILWAUKEE AVENUE, JANESVILLE, WI /01/014 04/0/016 GLENDALE ELEMENTARY SCHOOL, 101 TOMPKINS DRIVE, MADISON, WI 5716 SCHENK ELEMENTARY SCHOOL, 0 SCHENK STREET, MADISON, WI 5714 SENNETT MIDDLE SCHOOL, 50 PFLAUM RD, MADISON, WI /15/015 04/0/016 09/15/015 04/0/016 09/15/015 04/0/016 CHILD & FAMILY PSYCHOLOGICAL SERVICES CLINIC Lic #: S. YELLOWSTONE DR., #18 MADISON, WI 5719 Dane County NIRA SCHERZ-BUSCH Initial Cert: 07/01/198 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) /01/015 07/1/017 11/4/015 Page 1 of 186

22 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1716 FORDEM AVENUE MADISON, WI 5704 Dane County Lic #: 1188 MAUREEN ROBBINS Initial Cert: 0/01/1981 Phone: (608) /01/015 0/8/017 Fax: (608) /01/015 0/8/017 COMMUNITY SUPPORT NETWORK, INC DBA COLLABORATIONS Lic #: NORTH SHERMAN AVE MADISON, WI 5704 Dane County DEBORAH RAETTIG Initial Cert: 0/18/014 Phone: (608) /01/015 06/0/017 Fax: (608) /01/015 06/0/017 COMMUNITY SUPPORT NETWORK INC, 117 NORTH SHERMAN AVE, MADISON, WI /01/015 06/0/017 CONNECTIONS COUNSELING 5005 UNIVERSITY AVE STE #100 MADISON, WI 5705 Dane County Lic #: 407 SHELLY DUTCH Initial Cert: 01/01/00 Phone: (608) /01/015 0/1/017 Fax: (608) -101 CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 1 JEFFERSON CO HUMAN SVS-CONNECTIONS CNSLG, 1541 ANNEX RD, JEFFERSON, WI /01/015 0/1/017 1 PRES HOUSE, 71 STATE STREET MALL, MADISON, WI /0/016 0/1/017 DANE COUNTY HUMAN SERVICES CCS 10 NORTHPORT DRIVE MADISON, WI 5704 Dane County Lic #: 06 CARRIE SIMON Initial Cert: 07/01/015 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL POPULATION-BASED DHS 6 07/01/015 06/0/016 DANE COUNTY DHS - NEIGHBORHOOD INTERVENTION OFFICE, 17 N SHERMAN AVE, MADISON, WI 07/01/015 06/0/016 11/4/015 Page of 186

23 DANE COUNTY HUMAN SERVICES DEPT./JOURNEY MENTAL HEALTH CENTER Lic #: WEST MAIN ST MADISON, WI 570 Dane County LYNN A. BRADY Initial Cert: 0/01/006 Phone: (608) /01/015 0/8/017 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 0/01/015 0/8/017 0/01/015 0/8/017 FAMILY SERVICE OF MADISON, INC. 18 E. OLIN AVENUE, #100 MADISON, WI 571 Dane County Lic #: 17 DAVID JOHNSON Initial Cert: 04/01/1977 Phone: (608) /01/015 09/0/017 Fax: (608) 5-1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 INSIGHT COUNSELING & WELLNESS LLC 00 ATWOOD AVE, SUITE #17 MADISON, WI 5704 Dane County Lic #: 08 JEANNE KOLKER Initial Cert: 06/01/014 [email protected] Phone: (608) /01/015 05/1/017 Fax: (608) /01/015 05/1/017 INTEGRATED DEVELOPMENT SERVICES, INC. 559 ZOR SHRINE PLACE MADISON, WI 5719 Dane County Lic #: 9 BECKY BURNS Initial Cert: 09/01/00 [email protected] Phone: (608) /01/014 09/0/016 Fax: (608) INTEGRATED DEVELOPMENT SERVICES, 17 W. DUNWOOD ROAD, FOX POINT, WI /01/014 09/0/016 10/01/014 09/0/016 JOURNEY MENTAL HEALTH CENTER - FORWARD SOLUTIONS Lic #: MENDOTA ST SUITE 10 MADISON, WI 5714 Dane County KATHY ZAKARIAS Initial Cert: 09/01/1990 [email protected] Phone: (608) /01/014 10/1/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 Page of 186

24 JOURNEY MENTAL HEALTH CENTER GATEWAY COMMUNITY SUPPORT PROGRAM Lic #: S PARK STREET MADISON, WI 5715 Dane County JOSH PETERSON Initial Cert: 09/01/1990 [email protected] Phone: (608) /01/015 01/1/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/015 01/1/017 JOURNEY MENTAL HEALTH CENTER INC 65 W WASHINGTON AVE MADISON, WI 570 Dane County Lic #: 1596 LYNN BRADY Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 0/9/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 0/9/016 01/1/015 0/9/016 0/01/014 0/9/016 01/1/015 0/9/016 DEFOREST AREA MIDDLE SCHOOL, 404 YORKTOWN ROAD, DE FOREST, WI 55 05/7/015 06/11/015 SENNETT MIDDLE SCHOOL, 50 PFLAUM ROAD, MADISON, WI /1/015 06/11/015 JOURNEY MENTAL HEALTH CENTER-COMMUNITY TREATMENT ALTERNATIVES CSP Lic #: FORDEM AVE MADISON, WI 5704 Dane County DAVE DELAP Initial Cert: 0/01/199 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/014 01/1/016 JOURNEY MENTAL HEALTH CENTER-YAHARA HOUSE Lic #: E GORHAM STREET MADISON, WI 570 Dane County GAIL MARKER Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) MENTAL HEALTH-DAY TREATMENT DHS /01/014 01/1/016 11/4/015 Page 4 of 186

25 JUVENILE ASSESSMENT AND TREATMENT CENTER, LLC Lic #: ATWOOD AVENUE, #10 MADISON, WI 5704 Dane County LORRIE ROLLER Initial Cert: 1/01/00 Phone: (608) /01/015 11/0/016 Fax: () - 1/01/015 11/0/016 MADISON PSYCHOTHERAPY CENTER LLC 70 N BLACKHAWK AVENUE #05 MADISON, WI 5705 Dane County Lic #: 155 MARY ELLEN MILLER Initial Cert: 11/01/199 [email protected] Phone: (608) /01/014 09/0/016 Fax: (608) /01/014 09/0/016 MARRIAGE & FAMILY SOLUTIONS LLC 7818 BIG SKY DRIVE #101 MADISON, WI 5719 Dane County Lic #: 78 CRYSTAL D'ORAZIO Initial Cert: 06/08/007 [email protected] Phone: (608) /01/014 05/1/016 Fax: (608) /01/014 05/1/016 MENTAL HEALTH RESOURCES 40 GAMMON PLACE, #90 MADISON, WI 5719 Dane County Lic #: 160 SUSAN A BROWN PHD Initial Cert: 04/01/1990 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM Lic #: S. PARK STREET MADISON, WI 5715 Dane County SUSAN JANTY Initial Cert: 01/01/1984 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 11/4/015 Page 5 of 186

26 MERITER NEWSTART OUTPATIENT CLINIC 1015 GAMMON LANE MADISON, WI 5719 Dane County Lic #: 1617 SUE JANTY Initial Cert: 01/01/1988 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 MERITER'S CHILD & ADOLESCENT PSYCHIATRIC HOSPITAL Lic #: RAYMOND ROAD MADISON, WI 5719 Dane County SUSAN JANTY Initial Cert: 01/01/1984 Phone: (608) /01/014 11/0/016 Fax: (608) MENTAL HEALTH-ADOLESCENT INPATIENT DHS /01/014 11/0/016 NORTHSTAR COUNSELING CENTER 6506 SCHROEDER RD MADISON, WI 5719 Dane County Lic #: 1685 BEN FARBMAN Initial Cert: 11/01/1991 Phone: (608) /04/015 10/1/016 Fax: (608) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 08/04/015 10/1/016 OPEN DOOR CENTER FOR CHANGE LLC 650 GRAND TETON PLAZA #10 MADISON, WI 5719 Dane County Lic #: 06 AMY MOSHER GARVEY Initial Cert: 09/01/1996 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) /01/014 08/1/016 ORION FAMILY SERVICES, INC. 6 ODANA ROAD, #0 MADISON, WI 5719 Dane County Lic #: 09 STACEY PARKE Initial Cert: 07/1/001 [email protected] Phone: (608) /01/014 07/1/016 Fax: (608) /01/014 07/1/016 11/4/015 Page 6 of 186

27 PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT (PACT) Lic #: WILLIAMSON STREET, #A-B MADISON, WI 570 Dane County JANA LANE FREY Initial Cert: 09/01/1989 Phone: (608) /01/015 09/0/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/015 09/0/017 REGENT MENTAL HEALTH GROUP 6515 WATTS ROAD #06 MADISON, WI 5719 Dane County Lic #: 1786 DIANE KOHRS Initial Cert: 09/01/1979 [email protected] Phone: (608) /01/015 08/1/017 Fax: (608) /01/015 08/1/017 ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM Lic #: SCIENCE DRIVE RM #110 & 00 MADISON, WI 5711 Dane County DAVID GEBAUER Initial Cert: 10/1/010 [email protected] Phone: (608) /01/015 10/1/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 SOAR CASE MANAGEMENT 05 ATWOOD AVE MADISON, WI 5704 Dane County Lic #: 096 TRACY ZEMLO Initial Cert: 07/0/015 [email protected] Phone: (608) /0/015 06/0/016 Fax: (608) /0/015 06/0/016 ST. MARYS HOSPITAL MEDICAL CENTER 700 S. PARK STREET MADISON, WI 5715 Dane County Lic #: 187 CHRISTINA MIGNON Initial Cert: 06/01/198 [email protected] Phone: (608) /01/014 05/1/016 Fax: (608) MENTAL HEALTH-INPATIENT DHS /01/014 05/1/016 11/4/015 Page 7 of 186

28 THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC Lic #: WALL STREET, #500 MADISON, WI 5718 Dane County KEVIN RANDALL Initial Cert: 0/01/198 Phone: (608) /01/014 0/1/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 0/01/014 0/1/016 THE FAMILY CENTER 805 EXCELSIOR DRIVE, #110 MADISON, WI 5717 Dane County Lic #: 857 BETTY RYGIEWICZ Initial Cert: 07/0/009 Phone: (608) /01/014 08/1/016 Fax: (608) /01/014 08/1/016 THE INTEGRAL PSYCHOLOGY CENTER 1619 MONROE ST MADISON, WI 5711 Dane County Lic #: 1914 ARDEN MAHLBERG Initial Cert: 05/01/1979 Phone: (608) /01/014 04/0/016 Fax: (608) /01/014 04/0/016 THE PSYCHOLOGY CLINIC, INC. 10 N MIDVALE BOULEVARD #0 MADISON, WI 5705 Dane County Lic #: 1919 JAMES BLACK, PHD Initial Cert: 10/01/1991 [email protected] Phone: (608) /01/014 10/1/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 1 AIDS NETWORK, 600 WILLIAMSON STREET, MADISON, WI /01/014 01/1/015 1 THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 1, WISCONSIN DELLS, WI /01/014 10/1/016 THE PSYCHOLOGY CLINIC, INC - BARABOO, 701 ASH STREET, BARABOO, WI 591 THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC, 1190 PRAIRIE STREET, PRAIRIE DU SAC, WI 5578 SAUK PRAIRIE HIGH SCHOOL, 105 NINTH STREET, PRAIRIE DU SAC, WI /01/014 10/1/016 11/01/014 10/1/016 08/5/016 10/1/016 11/4/015 Page 8 of 186

29 THE RAINBOW PROJECT, INC. 81 E. WASHINGTON AVENUE MADISON, WI 570 Dane County Lic #: 190 SHARYL KATO Initial Cert: 05/01/1988 Phone: (608) /01/015 05/1/017 Fax: (608) /01/015 05/1/017 UNIVERSITY OF WI HOSPITALS & CLINICS 1 E. OLIN AVENUE, #75 MADISON, WI 571 Dane County Lic #: 1940 CYNTHIA GREEN Initial Cert: 11/01/1990 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 01/1/016 0/01/014 01/1/016 UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY Lic #: HIGHLAND AVE, AOB-414 MADISON, WI 579 Dane County JACKIE SMITH-HELMANSTEIN Initial Cert: 01/01/1987 [email protected] Phone: (608) /01/015 10/1/017 Fax: (608) MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 WELLSPRING PSYCHOTHERAPY AND COUNSELING CENTER Lic #: MEDICAL CIRCLE, SUITE 5 MADISON, WI 5719 Dane County BRYCE MITCHELL Initial Cert: 07/01/1996 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) /01/015 06/0/017 WESTSIDE PSYCHOTHERAPY 1 PRICE PLACE, SUITE 08 MADISON, WI 5705 Dane County Lic #: 056 SANDRA EUGSTER Initial Cert: 01/01/015 [email protected] Phone: (608) /01/015 1/1/015 Fax: (608) /01/015 1/1/015 11/4/015 Page 9 of 186

30 WISCONSIN EARLY AUTISM PROJECT, INC. 110 FOURIER DRIVE SUITE 100 MADISON, WI 5717 Dane County Lic #: 1996 KIM SCHUTT-CHARDON Initial Cert: 05/01/1997 Phone: (608) /01/015 04/0/017 Fax: (608) /01/015 04/0/017 WISCONSIN PSYCHOTHERAPY AND HEALING CENTER Lic #: ODANA ROAD SUITE 1 MADISON, WI 5719 Dane County KAY PHILLIPS Initial Cert: 09/01/199 wisconsinpsychotherapyinc@earthli Phone: (608) /01/014 08/1/016 Fax: (608) /01/014 08/1/016 COMMON THREADS FAMILY RESOURCE CENTER Lic #: SIGGELKOW ROAD MC FARLAND, WI 5558 Dane County Surveyor: William Rohner ELLEN EGGEN Initial Cert: 04/01/008 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) /01/015 09/0/017 COMMON THREADS FAMILY RESOURCE CENTER - IVYWOOD, 4800 IVYWOOD TRAIL, MC FARLAND, W 10/01/015 09/0/017 COMMUNITY CARE PROGRAMS, INC STONE GLEN DRIVE MIDDLETON, WI 556 Dane County Lic #: 10 DANIEL SIMON Initial Cert: 0/01/1994 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 1 ADAMS CNTY DEPT H&HS, 108 E. NORTH ST, FRIENDSHIP, WI /01/015 0/1/017 1 JEFFERSON COUNTY DEPT. OF HUMAN SERVICES, 1541 ANNEX ROAD, JEFFERSON, WI /01/015 0/1/017 ROCK CNTY DEPT OF HUMAN SVS, 50 N COUNTY TRK HWY F, JANESVILLE, WI /01/015 0/1/017 11/4/015 Page 0 of 186

31 COMMUNITY COUNSELING CENTER OF MADISON, INC. Lic #: UNIVERSITY AVENUE, #09 MIDDLETON, WI 556 Dane County MARY OLSON Initial Cert: 01/01/1998 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) /01/014 01/1/016 ECLIPSE COUNSELING, LLC 100 RIVER PLACE, #60 MONONA, WI 5716 Dane County Surveyor: William Rohner Lic #: 85 MARTIN KEANE Initial Cert: 05/08/009 [email protected] Phone: (608) /01/014 07/1/016 Fax: (608) /01/014 07/1/016 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN Lic #: MONONA DRIVE #100 MONONA, WI 5716 Dane County Surveyor: William Rohner DAN FEASTER Initial Cert: 09/01/1994 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) /01/015 07/1/017 1 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN, 109 FIRST STREET, LODI, WI /01/015 07/1/017 1 WEST MADISON - GOOD SHEPERD LUTHERAN CHURCH, 5701 RAYMOND RD, MADISON, WI /01/015 07/1/017 SANKOFA BEHAVIORAL & COMMUNITY HEALTH 6400 GISHOLT DR, SUITE 09 MONONA, WI 571 Dane County Lic #: 010 VALERIE HENDERSON, PHD Initial Cert: 11/01/01 [email protected] Phone: (414) /01/015 11/0/015 Fax: (608) /01/015 11/0/015 1 SANKOFA BEHAVIORAL & COMMUNITY HEALTH, 500 W SILVER SPRING DR. SUITE K-00, GLENDALE, 11/01/015 11/0/015 11/4/015 Page 1 of 186

32 TELLURIAN OUTPATIENT CLINIC 00 FEMRITE DR - ND FLOOR MONONA, WI 5716 Dane County Lic #: 1901 SARAH LIM Initial Cert: 04/7/011 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) CSAS-INTERVENTION DHS CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 OREGON MENTAL HEALTH SERVICES 165 W NETHERWOOD ST OREGON, WI 5575 Dane County Surveyor: William Rohner Lic #: 51 MARY SELLA Initial Cert: 05/01/004 [email protected] Phone: (608) /4/015 04/0/017 Fax: (608) /4/015 04/0/017 1 OREGON MENTAL HEALTH SERVICES LLC, 110 W. LINDEN DRIVE SUITE B, JEFFERSON, WI /4/015 04/0/017 NETHERWOOD KNOLL ELEMENTARY SCHOOL, 76 SODEN DR., OREGON, WI 5575 OREGON HIGH SCHOOL, 456 N. PERRY PARKWAY, OREGON, WI 5575 ROME CORNERS INTERMEDIATE SCHOOL, 1111 S. PERRY PARKWAY, OREGON, WI /4/015 04/0/017 08/4/015 04/0/017 08/4/015 04/0/017 OCEANHAWK COUNSELING ALTERNATIVES, LLC Lic #: W MAIN STREET, #07A STOUGHTON, WI 5589 Dane County Surveyor: William Rohner JEAN DAUTE Initial Cert: 07/17/006 [email protected] Phone: (608) /01/015 06/0/017 Fax: (877) CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 STOUGHTON HOSPITAL 900 RIDGE STREET STOUGHTON, WI 5589 Dane County Surveyor: William Rohner Lic #: 1884 HEATHER KLEINBROOK Initial Cert: 09/01/1997 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) 87-9 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 11/4/015 Page of 186

33 HEALING HEARTS FAMILY COUNSELING CENTER, LLC Lic #: W MAIN STREET, # SUN PRAIRIE, WI 5590 Dane County PAT ANN ST. GERMAIN Initial Cert: 09/0/010 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) /01/015 09/0/017 PRAIRIE COUNSELING SERVICES 1460 W. MAIN STREET #6 SUN PRAIRIE, WI 5590 Dane County Lic #: 174 CATHRYN HUBBARD Initial Cert: 07/01/1978 [email protected] Phone: (608) /01/014 07/1/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: LOIS DRIVE SUN PRAIRIE, WI 5590 Dane County TIM PERRY Initial Cert: 08/18/009 [email protected] Phone: (608) /01/015 08/1/017 Fax: (608) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/017 11/4/015 Page of 186

34 Dodge County AFFILIATED COUNSELING CENTER, LLC 108 N LINCOLN AVENUE BEAVER DAM, WI 5916 Dodge County Lic #: 1018 SANDRA SCHWEFEL-MASSIE Initial Cert: 11/01/1989 [email protected] Phone: (90) /01/015 09/0/017 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 1 AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI /01/015 09/0/017 AGNESIAN HEALTHCARE, D.B.A. PSYCHIATRIC ASSOCIATES Lic #: FRONT STREET, #D BEAVER DAM, WI 5916 Dodge County JIM SALASEK Initial Cert: 10/01/1984 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 WAYLAND ACACDEMY COUNSELING SERVICES - SCHOEN, 101 NORTH UNIVERSITY AVE, BEAVER DA 0/7/015 06/0/016 DODGE COUNTY HUMAN SERVICES & HEALTH DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 1/11/007 [email protected] Phone: (90) /01/01 11/0/015 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 11/0/015 1/01/01 1/1/014 11/4/015 Page 4 of 186

35 DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT Lic #: COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 10/01/1975 Phone: (90) /01/015 0/8/017 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/015 09/0/016 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 LOMIRA SCHOOL, 100 4TH ST., LOMIRA, WI /01/015 0/8/017 MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI /01/015 0/8/017 MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 01, MAYVILLE, WI /01/015 0/8/017 ROCK RIVER INTERMEDIATE SCHOOL, 451 E. SPRING ST. RM 15 B, WAUPUN, WI 596 0/01/015 0/8/017 VAN BRUNT ELEMENTARY, 611 MILL ST. RM 447, HORICON, WI 50 0/01/015 0/8/017 DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT CSP Lic #: COUNTY ROAD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 01/01/1999 Phone: (90) /01/015 09/0/017 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/015 09/0/017 WATERTOWN PHYSICIAN PRACTICES, LLC DBA WRMC DIRECTIONS COUNSELING CENTER Lic #: HOSPITAL DRIVE WATERTOWN, WI 5098 Dodge County ERIC D BEAVER Initial Cert: 11/01/1981 [email protected] Phone: (90) /01/015 1/1/015 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/015 09/01/015 1/1/015 1 WRMC LAKE MILLS CLINIC, 105 MULBERRY STREET, LAKE MILLS, WI /01/015 1/1/015 11/4/015 Page 5 of 186

36 Door County BAY COUNSELING CLINIC 50 SOUTH MADISON AVE SUITE STURGEON BAY, WI 545 Door County Lic #: 871 JEANNA GRAHL Initial Cert: 07/01/009 Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 COUNSELING ASSOCIATES OF DOOR COUNTY LLC Lic #: N 1TH AVENUE STURGEON BAY, WI 545 Door County WILLIAM G NICK Initial Cert: 11/16/199 [email protected] Phone: (90) /01/014 11/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1 COUNSELING ASSOCIATES OF DOOR COUNTY -GB, 0 SOUTH BROADWAY, GREEN BAY, WI 540 1/01/014 11/0/016 1 COUNSELING ASSOCIATES OF DOOR COUNTY, 711 HWY 4, FISH CREEK, WI 541 1/01/014 09/0/015 DR. ROSA MINOKA-HILL SCHOOL, 5 N. ROOSEVELT, GREEN BAY, WI /0/015 11/0/016 DOOR COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: NEBRASKA STREET STURGEON BAY, WI 545 Door County CORI MCFARLANE Initial Cert: 01/01/1978 [email protected] Phone: (90) /01/014 09/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 DOOR COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: NEBRASKA STREET STURGEON BAY, WI 545 Door County SHERYL FLORES Initial Cert: 10/01/1999 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 11/4/015 Page 6 of 186

37 DOOR COUNTY DEPT OF HUMAN SERVICES - CCS Lic #: NEBRASKA STREET STURGEON BAY, WI 545 Door County CORINNE MCFARLANE Initial Cert: 1/01/014 [email protected] Phone: (90) /01/015 11/0/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 1/01/015 11/0/016 11/4/015 Page 7 of 186

38 Douglas County DOUGLAS CO DEPT HLTH & HUMAN SVS/HUMAN DEVELOPMENT CTR Lic #: N 4TH STREET, #00 SUPERIOR, WI Douglas County Surveyor: Polly Wong STEVEN ENGLESON Initial Cert: 07/01/010 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/014 06/0/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER Lic #: N 4TH STREET, #00 SUPERIOR, WI Douglas County Surveyor: Polly Wong BETSY BYLER Initial Cert: 1/01/198 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 BRYANT ELEMENTARY SCHOOL, 14 CENTRAL AVE, SUPERIOR, WI /01/014 06/0/016 COOPER ELEMENTARY, 1807 MISSOURI AVE., SUPERIOR, WI /0/016 06/0/016 FOUR CORNERS ELEMENTARY, 4465 COUNTY RD. B, SUPERIOR, WI /0/016 06/0/016 GREAT LAKES ELEMENTARY, 19 N. 8TH ST. EAST, SUPERIOR, WI /0/016 06/0/016 LAKE SUPERIOR ELEMENTARY, 600 E. RD ST., SUPERIOR, WI /0/016 06/0/016 NORTHERN LIGHTS ELEMENTARY, 101 NORTH 8TH ST, SUPERIOR, WI /01/014 06/0/016 NORTHWESTERN ELEMENTARY SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI /01/014 06/0/016 NORTHWESTERN HIGH SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI /01/014 06/0/016 NORTHWESTERN MIDDLE SCHOOL, 105 EAST US HWY, POPLAR, WI /01/014 06/0/016 SOLON SPRINGS SCHOOL, 899 EAST BALDWIN AVE, SOLON SPRINGS, WI /01/014 06/0/016 SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI /01/014 06/0/016 SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI /01/014 06/0/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM Lic #: N 4TH ST #00 SUPERIOR, WI Douglas County Surveyor: Polly Wong STEVE ENGLESON Initial Cert: 1/01/198 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 THE CREATIVE COUNSELING GROUP, LLC 15 TOWER AVENUE, STE 108 SUPERIOR, WI Douglas County Surveyor: Polly Wong Lic #: 111 DONALD MATTSON Initial Cert: 11/11/015 [email protected] Phone: (715) /11/015 10/1/016 Fax: (715) /11/015 10/1/016 11/4/015 Page 8 of 186

39 Dunn County ARBOR PLACE, INC KOTHLOW AVE MENOMONIE, WI Dunn County Surveyor: Roderic Senn Lic #: 1050 JILL GAMEZ Initial Cert: 1/01/199 Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 DUNN COUNTY DEPARTMENT OF HUMAN SERVICES BEHAVIORAL HEALTH SERVICES Lic #: US HWY 1 EAST, SUITE 160 MENOMONIE, WI Dunn County Surveyor: Roderic Senn VICKI RADMANN Initial Cert: 01/01/1981 [email protected] Phone: (715) /1/015 05/1/016 Fax: (715) /1/015 05/1/016 DUNN COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: US HWY 1 EAST, SUITE 160 MENOMONIE, WI Dunn County Surveyor: Roderic Senn JOCELYN LINGEL-KUFNER Initial Cert: 06/01/1998 [email protected] Phone: (715) /01/015 05/1/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 06/01/015 05/1/017 MAYO CLINIC HEALTH SYSTEM RED CEDAR 411 STOUT ROAD MENOMONIE, WI Dunn County Surveyor: Roderic Senn Lic #: 1780 DANIELLE HAUBRICH Initial Cert: 11/01/199 [email protected] Phone: (715) /01/014 10/1/016 Fax: (715) /01/014 10/1/016 11/4/015 Page 9 of 186

40 NORTHWEST DIRECTIONS - MENOMONIE 40 TECHNOLOGY DRIVE EAST MENOMONIE, WI Dunn County Surveyor: Roderic Senn Lic #: 94 REBECCA MCCURDY Initial Cert: 07/6/010 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/015 01/1/017 0/01/015 01/1/017 1 NORHTWEST DIRECTIONS-STEVENS POINT, 55-4TH AVENUE, STEVENS POINT, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-AMERY, PO BOX 167, 1096 APPLE AVENUE, AMERY, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-BLACK RIVER FALLS, N664 COUNTY ROAD A, BLACK RIVER FALLS, WI 54 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-CHIPPEWA FALLS, 705 BAY STREET, #E, CHIPPEWA FALLS, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-GREEN BAY, 1 SOUTH VAN BUREN STREET, GREEN BAY, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-SIREN, 7670 JOHNSON STREET, SIREN, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-WAUPACA COUNTY, 10 E MAIN STREET, WEYAUWEGA, WI /01/015 01/1/017 1 NORTHWEST DIRECTIONS-WAUSAU, 805 EMERY DRIVE, WAUSAU, WI /01/015 11/08/015 1 NORTHWEST DIRECTIONS-WAUSAU, 5665 N 8TH AVENUE, WAUSAU, WI /09/015 01/1/017 1 NORTHWEST DIRECTIONS-WISCONSIN RAPIDS, 110-4TH STREET SOUTH, WISCONSIN RAPIDS, WI 0/01/015 01/1/017 BLACK RIVER FALLS HIGH SCHOOL, 100 PIERCE ST, BLACK RIVER FALLS, WI BLACK RIVER FALLS MIDDLE SCHOOL, 10 PIERCE ST, BLACK RIVER FALLS, WI CHETEK MIDDLE & HIGH SCHOOL, 1001 KNAPP STREET, CHETEK, WI 5478 CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA BOULEVARD, CHIPPEWA FALLS, WI 5479 CHIPPEWA FALLS SENIOR HIGH SCHOOL, 75 TERRILL STREET, CHIPPEWA FALLS, WI 5479 COLFAX ELEMENTARY SCHOOL, 80 COLFAX STREET, COLFAX, WI 5470 COLFAX MIDDLE/HIGH SCHOOL, 601 UNIVERSITY AVENUE, COLFAX, WI 5470 FOREST STREET ELEMENTARY SCHOOL, 70 FOREST STREET, BLACK RIVER FALLS, WI FREDERIC ELEMENTARY SCHOOL, 05 BIRCH STREET, FREDERIC, WI 5487 FREDERIC MIDDLE/HIGH SCHOOL, 147 CLAM FALLS DRIVE, FREDERIC, WI 5487 GEBHARDT ELEMENTARY SCHOOL, 411 GEBHARDT ROAD, BLACK RIVER FALLS, WI HALMSTAD ELEMENTARY SCHOOL, 565 E SOUTH AVENUE, CHIPPEWA FALLS, WI 5479 HILLCREST ELEMENTARY SCHOOL, 100 MILES STREET, CHIPPEWA FALLS, WI 5479 JIM FALLS ELEMENTARY SCHOOL, TH STREET, JIM FALLS, WI LAGRANGE ELEMENTARY SCHOOL, 600 STRAW STREET, TOMAH, WI LEOMONWEIR ELEMENTARY SCHOOL, 711 N. GLENDALE AVENUE, TOMAH, WI MENOMONIE HIGH SCHOOL, TH STREET WEST, MENOMONIE, WI MENOMONIE MIDDLE SCHOOL, 90 1ST STREET EAST, MENOMONIE, WI OAKLAWN ELEMENTARY SCHOOL, 500 1ST STREET SE, MENOMONIE, WI OSCEOLA ELEMENTARY SCHOOL, 50 10TH AVENUE EAST, OSCEOLA, WI 5400 OSCEOLA HIGH SCHOOL, 1111 OAK RIDGE DRIVE, OSCEOLA, WI 5400 OSCEOLA INTERMEDIATE SCHOOL, 949 EDUCATION DRIVE, OSCEOLA, WI 5400 OSCEOLA MIDDLE SCHOOL, 109 OAK RIDGE DRIVE, OSCEOLA, WI 5400 PARKVIEW ELEMENTARY SCHOOL, 501 JEFFERSON AVENUE, CHIPPEWA FALLS, WI 5479 RIVER HEIGHTS ELEMENTARY SCHOOL, 615 4TH AVENUE S, MENOMONIE, WI ROSELAWN ELEMENTARY, 101 6TH STREET, CHETEK, WI 5478 SOUTHVIEW ELEMENTARY SCHOOL, 615 A. STREET, CHIPPEWA FALLS, WI 5479 ST. CROIX FALLS ELEMENTARY, 651 E. LOUISIANA ST., ST CROIX FALLS, WI 5404 ST. CROIX FALLS MIDDLE/HIGH SCHOOL, 740 MAPLE DR., ST CROIX FALLS, WI 5404 STILLSON ELEMENTARY SCHOOL, 1750 COUNTY HIGHWAY J, CHIPPEWA FALLS, WI 5479 THIRD STREET ELEMENTARY SCHOOL, 06 N RD STREET, BLACK RIVER FALLS, WI TOMAH MIDDLE SCHOOL, 61 HOLLISTER AVENUE, TOMAH, WI WAKANDA ELEMENTARY SCHOOL, 1801 WAKANDA STREET NE, MENOMONIE, WI WEBSTER ELEMENTARY SCHOOL, 764 ALDER STREET WEST, WEBSTER, WI 5489 WEBSTER MIDDLE & HIGH SCHOOL, 7564 ALDER STREET WEST, WEBSTER, WI /01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 08/01/015 01/1/017 08/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 08/01/015 01/1/017 08/01/015 01/1/017 08/01/015 01/1/017 09/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 08/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 08/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 08/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 11/4/015 Page 40 of 186

41 NORTHWEST JOURNEY - MENOMONIE 40 TECHNOLOGY DRIVE EAST MENOMONIE, WI Dunn County Surveyor: Roderic Senn Lic #: 660 REBECCA MCCURDY Initial Cert: 0/01/006 [email protected] Phone: (715) /01/014 0/9/016 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/014 0/9/016 0/01/014 0/9/016 11/4/015 Page 41 of 186

42 Eau Claire County AUTISM AND BEHAVIOR CENTER, INC 919 S HILLCREST PKWY ALTOONA, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 7 KRISTIN WEGNER Initial Cert: 05/9/007 [email protected] Phone: (715) /08/015 05/1/016 Fax: (715) /08/015 05/1/016 FIRST THINGS FIRST COUNSELING & CONSULTING Lic #: N HILLCREST PKWY STE 01 ALTOONA, WI 5470 Eau Claire County Surveyor: Roderic Senn CHASTITY DRAKE Initial Cert: 09/01/1990 [email protected] Phone: (715) /01/015 07/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 CAILLIER CLINIC, LTD. 60 STEIN BLVD EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 1119 PAUL CAILLIER Initial Cert: 01/01/198 [email protected] Phone: (715) /18/015 11/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /18/015 11/0/016 05/18/015 11/0/016 1 CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 10, MENOMONIE, WI /18/015 11/0/016 CAILLIER CLINIC, LTD, 0 NORTH MAIN STREET, RICE LAKE, WI /18/015 11/0/016 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 004 HIGHLAND AVE SUITE N EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 1186 KRISTINE PARKINS Initial Cert: 09/01/198 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) /01/014 1/1/015 DAVEY ELEMENTARY, 000 STARR AVE, EAU CLAIRE, WI /01/014 1/1/015 LOCUST LANE ELEMENTARY, 45 LOCUST LANE, EAU CLAIRE, WI /01/014 1/1/015 MANZ ELEMENTARY, 1000 EAST FILLMORE AVE, EAU CLAIRE, WI /01/014 1/1/015 ROOSEVELT ELEMENTARY SCHOOL, 010-8TH STREET, EAU CLAIRE, WI /01/014 1/1/015 11/4/015 Page 4 of 186

43 CLINIC FOR CHRISTIAN COUNSELING, LLC 505 S DEWEY, #08 EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 701 PHILIP KOESTLER Initial Cert: 01/0/007 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) CLINIC FOR CHRISTIAN COUNSELING, LLC, 1 W MARSHALL STREET, #104, RICE LAKE, WI /01/014 1/1/015 01/01/014 1/1/015 CRESTVIEW ACADEMY, 1519 PETERSON AVE, EAU CLAIRE, WI /01/014 1/1/015 EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: OXFORD AVENUE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn RON HON Initial Cert: 09/09/008 [email protected] Phone: (715) /01/015 08/1/017 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/015 08/1/017 EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: OXFORD AVENUE EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn RON HON Initial Cert: 01/01/1990 [email protected] Phone: (715) /01/014 0/9/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/014 0/9/016 GREAT LAKES BEHAVIORAL HEALTH 550 NORTH DEWEY STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 99 VERA MATTER Initial Cert: 0/01/01 [email protected] Phone: (715) /01/015 08/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 1 GREAT LAKES BEHAVIORAL HEALTH, 1001 WEST LINCOLN AVE, WEST ALLIS, WI 57 09/01/015 08/1/017 1 MILWAUKEE ACADEMY, 9501 WATERTOWN PLANK ROAD, WAUWATOSA, WI 51 09/01/015 08/1/017 11/4/015 Page 4 of 186

44 LSS OF WI & UPPER MI FAMILY PRESERVATION PROGRAM Lic #: S BARSTOW STREET EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn MIKE BAUER Initial Cert: 07/0/008 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) /01/015 06/0/017 1 LSS OF WI & UPPER MI FAMILY PRESERVATION, 115 N 6TH STREET, WAUSAU, WI /01/015 1/1/015 LSS OF WI & UPPER MI: FAMILY PRESERVATION PROGRAM, 10 W CLAIREMONT AVE, EAU CLAIRE, 07/01/015 06/0/017 11/4/015 Page 44 of 186

45 MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: MONDOVI ROAD EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn THOMAS JOHNSTON Initial Cert: 09/01/198 Phone: (715) /01/014 04/0/016 Fax: (715) /01/014 04/0/016 11/4/015 Page 45 of 186

46 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 05/01/014 04/0/016 1 MARRIAGE & FAMILY HEALTH SERVICES, 1 W COLUMBIA STREET, CHIPPEWA FALLS, WI /01/014 04/0/016 1 MARRIAGE & FAMILY HEALTH SERVICES, 50 BUFFALO STREET, MONDOVI, WI /01/014 0/09/015 1 MARRIAGE & FAMILY HEALTH SERVICES, 905-7TH AVE WEST, DURAND, WI /01/014 04/0/016 1 MARRIAGE & FAMILY HEALTH SERVICES, P O BOX S ND STREET, ALMA, WI /01/014 04/0/016 MARRIAGE & FAMILY HEALTH SERVICES, 105 WEST AVENUE, RICE LAKE, WI MARRIAGE & FAMILY HEALTH SERVICES, 910 ENLOE ST, HUDSON, WI FALL CREEK ELEM, MIDDLE & HIGH SCHOOL, 6 E. HOOVER AVE., FALL CREEK, WI 5474 MFHS AUGUSTA ELEM. MIDDLE AND HIGH SCHOOL, E190 BARTIG ROAD, AUGUSTA, WI 547 MFHS- BARRON MIDDLE & HIGH SCHOOL, 1050 E WOODLAND AVE, BARRON, WI 5481 MFHS- CHIPPEWA FALLS MIDDLE SCHOOL, 750 TROPICANA, CHIPPEWA FALLS, WI 5479 MFHS- DELONG MIDDLE SCHOOL, 000 VINE ST, EAU CLAIRE, WI 5470 MFHS- ELEVA STRUM CENTRAL MIDDLE & HIGH SCHOOL, W 597 US HWY 10, STRUM, WI MFHS- FLYNN ELEMENTARY, 140 LEE ST, EAU CLAIRE, WI 5470 MFHS- HALMSTAD ELEMENTARY, 565 E SOUTH AVE, CHIPPEWA FALLS, WI 5479 MFHS- LAKESHORE ELEMENTARY, 711 LAKE STREET, EAU CLAIRE, WI 5470 MFHS- LONGFELLOW ELEMENTARY, 500 BALCOM ST, EAU CLAIRE, WI 5470 MFHS- MEMORIAL HIGH SCHOOL, 5 KEITH ST, EAU CLAIRE, WI MFHS- NORHTSTAR MIDDLE SCHOOL, 711 ABBE HILL DR, EAU CLAIRE, WI 5470 MFHS- NORTH HIGH SCHOOL, 1801 PIEDMONT RD, EAU CLAIRE, WI 5470 MFHS- NORTHWOODS ELEMENTARY, 600 NORTHWOODS, EAU CLAIRE, WI MFHS- OAK LAWN ELEMENTARY SCHOOL, 500 1ST STREET SOUTH, MENOMONIE, WI MFHS- PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI MFHS- SOUTH MIDDLE SCHOOL, 115 MITSCHER AVE, EAU CLAIRE, WI MFHS- TURTLE LAKE ELEMENTARY MID & HIGH SCHOOLS, 05 OAK STREET NORTH, TURTLE LAKE, W MFHS-ANDREW TAINTER ELEMENTARY, 01 CARRIE AVE, RICE LAKE, WI MFHS-BRUCE MIDDLE & HIGH SCHOOL, 104 W. WASHINGTON AVENUE, BRUCE, WI MFHS-CAMERON ELEMENTARY SCHOOL, 600 WISCONSIN AVENUE, CAMERON, WI 548 MFHS-CAMERON HIGH SCHOOL, 750 SOUTH 1ST STREET, CAMERON, WI 548 MFHS-CAMERON MIDDLE SCHOOL, 700 SOUTH 1ST STREET, CAMERON, WI 548 MFHS-CHETEK-WEYERHAEUSER MIDDLE/HIGH SCHOOL, 1001 KNAPP STREET, CHETEK, WI 5478 MFHS-CHIPPEWA FALLS HIGH SCHOOL, 75 TERRILL STREET, CHIPPEWA FALLS, WI 5479 MFHS-CUMBERLAND ELEMENTARY SCHOOL, 150 ND AVENUE, CUMBERLAND, WI 5489 MFHS-CUMBERLAND HIGH SCHOOL, TH AVENUE, CUMBERLAND, WI 5489 MFHS-CUMBERLAND MIDDLE SCHOOL, 980 8TH AVENUE, CUMBERLAND, WI 5489 MFHS-DURAND MIDDLE & HIGH SCHOOL, 604-7TH AVE. EAST, PO BOX 190, DURAND, WI 5476 MFHS-ELK MOUND HIGH SCHOOL, 405 UNIVERSITY ST., ELK MOUND, WI 5479 MFHS-ELK MOUND MIDDLE SCHOOL, 0 UNIVERSITY ST., ELK MOUND, WI 5479 MFHS-ELLSWORTH HIGH SCHOOL, HILLCREST STREET, ELLSWORTH, WI MFHS-ELLSWORTH MIDDLE SCHOOL, 1 WEST PANTHER DRIVE, ELLSWORTH, WI MFHS-HAUGEN ELEMENTARY, 615 W 5TH STREET, HAUGEN, WI MFHS-HILCREST ELEMENTARY, 100 MILES STREET, CHIPPEWA FALLS, WI 5479 MFHS-HILLCREST ELEMENTARY, 50 SOUTH GRANT STREET, ELLSWORTH, WI MFHS-HILLTOP ELEMENTARY, 0 CAMERON ROAD, RICE LAKE, WI MFHS-JEFFERSON ELEMENTARY, 0 PHIPPS AVENUE, RICE LAKE, WI MFHS-JIM FALLS ELEMENTARY, TH STREET, JIM FALLS, WI MFHS-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET, LADYSMITH, WI MFHS-MEADOWVIEW ELEMENTARY, 4714 FAIRFAX STREET, EAU CLAIRE, WI MFHS-MENOMONIE MIDDLE SCHOOL, 90 1ST STREET SE, MENOMONIE, WI MFHS-MEYER MIDDLE SCHOOL, 0 N. 9TH ST., RIVER FALLS, WI 540 MFHS-MOUND VIEW ELEMENTARY SCHOOL, 455 UNIVERSITY ST., ELK MOUND, WI 5479 MFHS-PARKVIEW ELEMENTARY, 501 JEFFERSON AVENUE, CHIPPEWA FALLS, WI 5479 MFHS-PRAIRIE VIEW ELEMENTARY, W TH AVENUE, HAGER CITY, WI MFHS-RICE LAKE HIGH SCHOOL, 0 SOUTH WISCONSIN, RICE LAKE, WI MFHS-RICE LAKE MIDDLE SCHOOL, 04 CAMERON ROAD, RICE LAKE, WI MFHS-RIVER FALLS HIGH SCHOOL, 818 CEMETERY RD., RIVER FALLS, WI 540 MFHS-ROBBINS ELEMENTARY, 8 E. HAMILTON AVENUE, EAU CLAIRE, WI /01/014 04/0/016 05/01/014 04/0/016 11/1/016 04/0/016 10/09/015 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 06/1/014 1/1/014 05/01/014 04/0/016 10/01/015 04/0/016 10/01/015 04/0/016 10/01/015 04/0/016 0/17/015 04/0/016 05/01/014 04/0/016 10/01/015 04/0/016 10/01/015 04/0/016 10/01/015 04/0/016 05/01/014 04/0/016 0/10/015 04/0/016 0/10/015 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 06/1/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 06/1/014 04/0/016 06/1/014 1/1/014 05/01/014 04/0/016 05/01/014 1/1/014 06/1/014 04/0/016 06/1/014 04/0/016 0/16/015 04/0/016 0/10/015 04/0/016 06/1/014 04/0/016 05/01/014 04/0/016 06/1/014 04/0/016 06/1/014 04/0/016 0/16/015 04/0/016 05/01/014 04/0/016 11/4/015 Page 46 of 186

47 MFHS-ROCKY BRANCH ELEMENTARY SCHOOL, 1415 S. BARTOSH LN., RIVER FALLS, WI 540 MFHS-ROOSEVELT ELEMENTARY, 010-8TH STREET, EAU CLAIRE, WI 5470 MFHS-ROSELAWN ELEMENTARY SCHOOL, 101 6TH STREET, CHETEK, WI 5478 MFHS-SHERMAN ELEMENTARY, 110 VINE STREET, EAU CLAIRE, WI 5470 MFHS-SOUTHVIEW ELEMENTARY, 615 A STREET, CHIPPEWA FALLS, WI 5479 MFHS-WAKANDA ELEMENTARY SCHOOL, 1801 WAKANDA STREET NE, MENOMONIE, WI MFHS-WOODLAND ELM SCHOOL, 808 E WOODLAND AVE, BARRON, WI /16/015 04/0/016 05/01/014 04/0/016 0/17/015 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 09/08/016 04/0/016 05/01/014 04/0/016 MARSHFIELD CLINIC EAU CLAIRE RIVERVIEW CTR PSYCHIATRY & BEHAVIORAL HEALTH Lic #: STARR AVENUE EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn CHRISTINE GUTSCH Initial Cert: 0/14/000 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 07/01/015 06/0/017 07/01/015 06/0/017 1 CHIPPEWA FALLS CENTER, 655 CO HWY I, CHIPPEWA FALLS, WI /01/015 06/0/017 1 EAU CLAIRE CENTER, 116 CRAIG RD, EAU CLAIRE, WI /01/015 06/0/017 1 LAKE HALLIE CENTER, TH AVE, CHIPPEWA FALLS, WI /01/015 06/0/017 1 MARSHFIELD CLINIC - LADYSMITH CENTER, 906 COLLEGE AVENUE, WEST, LADYSMITH, WI /01/015 06/0/017 MARSHFIELD CLINIC - LAKEWOODS CENTER, 115 WEST KNAPP ST, RICE LAKE, WI /01/015 06/0/017 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC Lic #: WHIPPLE STREET EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn KARLENE PHILLIPS Initial Cert: 06/01/1981 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 MAYO CLINIC HEALTH SYSTEM EAU CLAIRE 11 WHIPPLE STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 151 CINDY MING Initial Cert: 10/01/1981 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) 88-0 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM - OSSEO, 105-8TH STREET, OSSEO, WI /07/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM-BLOOMER CLINIC, 1501 THOMPSON STREET, BLOOMER, WI /01/015 1/1/015 MAYO CLINIC HEALTH SYSTEM NORTHLAND, 1 S MAIN STREET, RICE LAKE, WI MAYO CLINIC HEALTH SYSTEMS - CHIPPEWA FALLS OFFICE, 611 1ST AVENUE, CHIPPEWA FALLS, WI 01/01/015 1/1/016 01/01/015 1/1/016 11/4/015 Page 47 of 186

48 SACRED HEART BEHAVIORAL HEALTH CLINIC 45 SOUTHTOWNE DRIVE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 947 KIM JOHNSON Initial Cert: 10/1/011 Phone: (715) /01/014 09/0/016 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 10/01/014 09/0/016 10/01/014 09/0/016 1 SACRED HEART BEHAVIORAL HEALTH CLINIC, TULGREN SQUARE, 50 - ND STREET, HUDSON, WI 5 10/01/014 09/0/016 1 SACRED HEART HOSPITAL, 900 W. CLAIREMONT AVENUE, EAU CLAIRE, WI /01/014 09/0/016 SACRED HEART HOSPITAL 900 W. CLAIREMONT AVENUE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 09 THERESA MACKEY Initial Cert: 0/01/198 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER Lic #: HIGHLAND AVE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn MARK BJERKE Initial Cert: 08/01/1990 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 1 VANTAGE POINT CLINIC & ASSESSMENT CENTER, 54 GOLF ROAD, SUITE #F, EAU CLAIRE, WI /01/015 08/1/016 SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 144 B EAST DIVISION AVE, BARRON, W SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 40 S BARSTOW STREET, #, EAU CLAI CAMERON HIGH SCHOOL, 750 S 1ST STREET, CAMERON, WI 548 CAMERON MIDDLE SCHOOL, 700 S 1ST STREET, CAMERON, WI 548 MANZ ELEMENTARY SCHOOL, 1000 E FILLMORE AVE, EAU CLAIRE, WI PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI ROBBINS ELEMENTARY, 8 E. HAMILTON AVE, EAU CLAIRE, WI WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVENUE, BARRON, WI /01/014 08/1/016 09/01/014 08/1/016 09/10/014 08/1/015 10/1/014 08/1/015 09/01/014 08/1/015 09/01/014 08/1/015 11/10/015 08/1/016 10/1/014 08/1/015 09/01/014 08/1/015 09/10/014 08/1/015 11/4/015 Page 48 of 186

49 WISCONSIN EARLY AUTISM PROJECT, INC. 15 HEIGHTS DRIVE SUITE F EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 440 KIM SCHUTT-CHARDON Initial Cert: 05/1/00 [email protected] Phone: (715) 8-06/01/015 05/1/017 Fax: (715) /01/015 05/1/017 11/4/015 Page 49 of 186

50 Fond Du Lac County AGNESIAN HEALTHCARE DBA DOLL AND ASSOCIATES Lic #: 6 40 CAMELOT DRIVE FOND DU LAC, WI 5495 Fond Du Lac County BETH ROGERS-DOLL Initial Cert: 07/05/000 [email protected] Phone: (90) /01/015 06/0/017 Fax: (90) /01/015 06/0/017 DELTA CENTER, LLC 196 E. THIRD STREET FOND DU LAC, WI 5495 Fond Du Lac County Lic #: 174 AIMEE MEYER Initial Cert: 01/18/1989 [email protected] Phone: (90) /01/015 1/1/016 Fax: (90) /01/015 1/1/016 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS Lic #: E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/01/1978 [email protected] Phone: (90) /01/014 1/1/015 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS Lic #: E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/18/006 [email protected] Phone: (90) /01/015 07/1/017 Fax: (90) COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 08/01/015 07/1/017 11/4/015 Page 50 of 186

51 MINERVA COUNSELING CENTER, LLC 49A SOUTH MAIN ST FOND DU LAC, WI 5495 Fond Du Lac County Lic #: 01 AMANDA ETLICHER Initial Cert: 11/18/01 Phone: (90) /01/014 11/0/016 Fax: (90) /01/014 11/0/016 ST. AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES Lic #: EAST DIVISION STREET FOND DU LAC, WI 5495 Fond Du Lac County JAMES SALASEK PHD Initial Cert: 05/01/1980 Phone: (90) /01/014 1/1/015 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 ST AGNES HOSPITAL BEHAVIORAL HEALTH SVS, 60 BROWN STREET, WAUPUN, WI /01/014 1/1/015 ST AGNES HOSPITAL BEHAV HLTH, 790 EASTGATE DRIVE, RIPON, WI ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI /01/014 06/18/015 06/19/015 1/1/015 Forest County FOREST COUNTY POTAWATOMI BEHAVIORAL HEALTH DEPARTMENT Lic #: MISH KO SWEN DRIVE CRANDON, WI 5450 Forest County TINA GARCIA Initial Cert: 04/01/1994 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 04/01/015 0/1/017 04/01/015 0/1/017 SOKAOGON CHIPPEWA HEALTH CLINIC 144 VAN ZILE ROAD CRANDON, WI 5450 Forest County Lic #: 194 DEBRA HILGART Initial Cert: 0/8/000 [email protected] Phone: (715) /01/015 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/015 0/01/015 1/1/015 11/4/015 Page 51 of 186

52 Grant County UNIFIED COMMUNITY SERVICES 00 W ALONA LANE LANCASTER, WI 581 Grant County Surveyor: Cynthia Lindgren Lic #: 194 CHERYL KNAPP Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 UNIFIED COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM Lic #: W. ALONA LANE LANCASTER, WI 581 Grant County Surveyor: Cynthia Lindgren CHERYL KNAPP Initial Cert: 07/01/1994 [email protected] Phone: (608) /01/014 09/0/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/014 09/0/016 1 UNIFIED COMMUNITY SERVICES - CSP, 11 PROFESSIONAL DRIVE, DODGEVILLE, WI 55 08/01/015 09/0/016 PLATTEVILLE FAMILY RESOURCE CENTER, INC N ELM STREET, #10 PLATTEVILLE, WI 5818 Grant County Surveyor: Cynthia Lindgren Lic #: 178 MARC K. WRUBLE Initial Cert: 09/08/1995 [email protected] Phone: (608) /01/014 09/0/016 Fax: (608) PLATTEVILLE FAMILY RESOURCE CENTER, INC, COUNTY K, DARLINGTON, WI PLATTEVILLE FAMILY RESOURCE CENTER, INC, 880 HWY 5 & 61, LANCASTER, WI /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 PLATTEVILLE FAMILY RESOURCE CENTER INC., 14 GRACE ST, DODGEVILLE, WI 55 10/01/014 09/0/016 11/4/015 Page 5 of 186

53 SOUTHWEST BEHAVIORAL SERVICES 1185 NORTH ELM STREET PLATTEVILLE, WI 5818 Grant County Surveyor: Cynthia Lindgren Lic #: 197 HEATHER JOHNSON Initial Cert: 0/01/000 Phone: (608) /01/015 0/9/016 Fax: (608) 4-05 MENTAL HEALTH-INPATIENT DHS /01/015 0/9/016 0/01/015 0/9/016 1 BLOOMFIELD MANOR, 151 COUNTY RD CH, DODGEVILLE, WI 55 0/01/015 0/9/016 1 BOSCOBEL CARE AND REHAB, 07 PARKER ST, BOSCOBEL, WI /01/015 0/9/016 1 GOOD SAMARITAN HOME, TH STREET, FENNIMORE, WI /01/015 0/9/016 1 GRAY'S NURSING HOME, 555 NORTH CHESTNUT ST, PLATTEVILLE, WI /01/015 0/9/016 1 HCR MANOR CARE, 100 NORTH WATER ST, PLATTEVILLE, WI /01/015 0/9/016 1 LANCASTER CARE CENTER, 150 S. MADISON ST, LANCASTER, WI 581 0/01/015 0/9/016 1 MINERAL POINTE CARE CENTER, 109 NORTH IOWA ST, MINERAL POINT, WI /01/015 0/9/016 1 ORCHARD MANOR, 8800 HWY 61, LANCASTER, WI 581 0/01/015 0/9/016 1 PINE VALLEY MANOR, 5951 CIRCLE VIEW DRIVE, RICHLAND CENTER, WI /01/015 0/9/016 1 PRAIRIE MAISON, 700 S. FREEMONT ST, PRAIRIE DU CHIEN, WI 581 0/01/015 0/9/016 1 SOUTHWEST HEALTH CTR EPIONE PAVILLION, 808 S. WASHINGTON ST, CUBA CITY, WI /01/015 0/9/016 1 UPLAND HILLS NURSING & REHAB CENTER, 800 COMPASSION WAY, DODGEVILLE, WI 55 0/01/015 0/9/016 11/4/015 Page 5 of 186

54 Green County GREEN COUNTY HUMAN SERVICES N15 STATE ROAD 81 MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren Lic #: 188 GREG HOLCOMB Initial Cert: 10/01/1975 Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 GREEN COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 8 N 15 STATE ROAD 81 MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren GREG HOLCOMB Initial Cert: 01/01/000 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/014 1/1/015 GREEN/LAFAYETTE REGIONAL COMPREHENSIVE COMMUNITY SERVICES Lic #: 085 N15 STATE RD 81 MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren SHARON FARREY Initial Cert: 06/01/015 [email protected] Phone: (608) /01/015 05/1/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 06/01/015 05/1/016 1 GREEN/LAFAYETTE REGIONAL CCS AT LAFAYETTE CTY HS, 67 MAIN ST., DARLINGTON, WI /01/015 05/1/016 MONROE CLINIC BEHAVIORAL HEALTH ND AVENUE MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren Lic #: 1915 TROY WHITEMAN Initial Cert: 05/01/1981 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) /01/015 07/1/017 1 MONROE CLINIC - FREEPORT BRANCH, 101 KIWANIS DRIVE, FREEPORT, IL /01/015 07/1/017 1 MONROE CLINIC - NEW GLARUS BRANCH, ND ST, NEW GLARUS, WI /01/015 07/1/017 11/4/015 Page 54 of 186

55 Green Lake County GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: COUNTY ROAD A GREEN LAKE, WI Green Lake County LINDA VAN NESS Initial Cert: 04/01/1977 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS CSAS-PREVENTION WITH TELEHEALTH DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP Lic #: COUNTY ROAD A GREEN LAKE, WI Green Lake County LINDA VAN NESS Initial Cert: 11/01/000 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/0/015 10/1/016 11/01/014 10/1/016 GREEN LAKE COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES Lic #: COUNTY ROAD A GREEN LAKE, WI Green Lake County LINDA VAN NESS Initial Cert: 08//005 [email protected] Phone: (90) /01/015 0/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 10/01/015 0/1/016 10/01/015 0/1/016 Hennepin County (MN) 11/4/015 Page 55 of 186

56 Iowa County UNIFIED COMMUNITY SERVICES 11 PROFESSIONAL DRIVE DODGEVILLE, WI 55 Iowa County Surveyor: Cynthia Lindgren Lic #: 194 CHERYL KNAPP Initial Cert: 10/01/1975 Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 Iron County IRON COUNTY HUMAN SERVICES - CCS 00 TACONTE STREET - SUITE 01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong Lic #: 079 CAROLYN KOLSON-JANOV Initial Cert: 07/01/015 [email protected] Phone: (715) /01/015 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES Lic #: TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/00 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS CSAS-PREVENTION WITH TELEHEALTH DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 1 IRON COUNTY HUMAN SERVICES DEPT & ASSOC, 567 RAILROAD STREET, MERCER, WI /01/015 0/8/017 HURLEY SCHOOL DISTRICT, 550 W RANGE VIEW DR, HURLEY, WI 5454 MERCER SCHOOL DISTRICT, 690 W MARGARET STREET, MERCER, WI /01/015 0/8/017 04/01/015 0/8/017 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES COMM SUPPORT PROGRAM Lic #: TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/007 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/8/017 11/4/015 Page 56 of 186

57 Jackson County HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH Lic #: 141 W9850 AIRPORT RD BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn TERRY GREENDEER Initial Cert: 05/01/199 Phone: (715) /01/014 10/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 NEKOOSA HEALTH OFFICE, 15 1ST STREET, NEKOOSA, WI /01/014 10/1/016 THREE RIVERS HOUSE, 74 MAIN STREET, LA CROSSE, WI /01/014 10/1/016 TOMAH HEALTH OFFICE, 774 HWY 1 EAST, TOMAH, WI /01/014 10/1/016 WELLNESS CENTER HEALTH OFFICE, S845 WHITE EAGLE ROAD, BARABOO, WI /01/014 10/1/016 WITTENBERG HEALTH OFFICE, N740 HWY 49 NORTH, WITTENBERG, WI /01/014 10/1/016 JACKSON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: HIGHWAY 54 WEST BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn BETH SMETANA Initial Cert: 05/01/010 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 JACKSON COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: HIGHWAY 54 WEST BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn HEATHER L. HAINZ Initial Cert: 01/01/01 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/016 09/01/015 08/1/016 KROHN CLINIC, LTD. 610 W ADAMS STREET BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn Lic #: 147 SHERIE SPAULDING BH MGR Initial Cert: 0/01/1988 [email protected] Phone: (715) /01/015 04/0/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 04/0/017 05/01/015 04/0/017 11/4/015 Page 57 of 186

58 NORTHWEST JOURNEY - BLACK RIVER FALLS N664 COUNTY ROAD A BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn Lic #: 655 JEN STEINKE Initial Cert: 0/01/006 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/015 01/1/017 0/01/015 01/1/017 FAMILY SOLUTIONS ASSOCIATES, LLP N9710 STATE HWY 108 MELROSE, WI 5464 Jackson County Surveyor: Roderic Senn Lic #: 14 SUE KAUFMANN Initial Cert: 07/01/1997 [email protected] Phone: (507) /01/014 06/0/016 Fax: (507) /01/014 06/0/016 11/4/015 Page 58 of 186

59 Jefferson County CATHOLIC CHARITIES, INC. 74 MADISON AVENUE FORT ATKINSON, WI 558 Jefferson County Surveyor: William Rohner Lic #: 48 JERILYN ROBINSON Initial Cert: 0/04/00 Phone: (90) /01/014 0/9/016 Fax: (608) /01/014 0/9/016 FORT HEALTH CARE BEHAVIORAL HEALTH 500 MCMILLEN STREET FORT ATKINSON, WI 558 Jefferson County Surveyor: William Rohner Lic #: 109 LAWRENCE MILLER Initial Cert: 1/01/1991 Phone: (90) /01/014 01/1/016 Fax: (90) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 01/1/016 0/1/014 01/1/016 1 FORT HEALTHCARE CAMBRIDGE, 704 KATIE COURT, CAMBRIDGE, WI 55 0/01/014 01/1/015 1 FORT HEALTHCARE JEFFERSON, 840 W RACINE ST, JEFFERSON, WI /01/014 01/1/015 FORT HEALTH CARE-SPECIALTY CLINIC, 611 SHERMAN AVE EAST, FORT ATKINSON, WI 558 FORT HEALTHCARE INTEGRATED FAM CARE CLINIC, 150 MADISON AVE, FORT ATKINSON, WI 558 0/0/014 01/1/016 0/01/014 01/1/016 JEFFERSON COUNTY HUMAN SERVICES 1541 ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner Lic #: 1449 KATHI CAULEY Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 06/01/014 05/1/016 06/01/014 05/1/016 06/01/014 05/1/016 JEFFERSON COUNTY HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner MAJORIE THORMAN Initial Cert: 06/01/000 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 06/01/014 05/1/016 11/4/015 Page 59 of 186

60 JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner KIMBERLY PROPP Initial Cert: 0/15/006 Phone: (90) /01/015 0/8/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 FAMILY RESOURCES ASSOCIATES, INC. 115 W. MAIN STREET WATERTOWN, WI 5094 Jefferson County Surveyor: William Rohner Lic #: 16 NIKKI KUEFFER Initial Cert: 11/01/199 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 FAMILY RESOURCES ASSOCIATES INC, 1 N MAIN STREET, LAKE MILLS, WI /01/014 10/1/016 11/4/015 Page 60 of 186

61 Juneau County JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: E LACROSSE STREET MAUSTON, WI 5948 Juneau County JOANN GEIGER Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: E LA CROSSE STREET RM # MAUSTON, WI 5948 Juneau County JOANN GEIGER Initial Cert: 04/01/01 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM Lic #: E LACROSSE STREET MAUSTON, WI 5948 Juneau County MARY JO ONSAGER Initial Cert: 01/01/1989 [email protected] Phone: (608) /01/015 11/0/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page 61 of 186

62 Kenosha County AALTO ENHANCEMENT CENTER, SC TH STREET, #A KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 108 KATHRYN A. AALTO Initial Cert: 04/09/1991 Phone: (6) /01/015 04/0/017 Fax: (6) /01/015 04/0/017 AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES Lic #: ST STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATE CONNELLY Initial Cert: 09/4/1998 Phone: (414) /01/015 09/0/017 Fax: (414) /01/015 09/0/017 1 AURORA BEHAVIORAL HEALTH SVS-KENOSHA NORTH, TH PL., KENOSHA, WI /01/015 09/0/017 1 AURORA BEHAVIORAL HEALTH SVS-RACINE WEST, 848 WASHINGTON AVE., RACINE, WI /01/015 09/0/017 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 807 ND AVENUE, SUITE 155 KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 119 GRETCHEN HULETZ Initial Cert: 10/01/199 [email protected] Phone: (6) /01/015 09/0/017 Fax: (6) /01/015 09/0/017 WALWORTH COUNTY CHILD ADVOCACY CENTER, W406 HWY, NN, ELKHORN, WI /01/015 09/0/017 INTERCONNECTIONS, S.C TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner Lic #: 1440 DEBORAH BISSLAND Initial Cert: 08/01/1981 [email protected] Phone: (6) /01/015 1/1/016 Fax: (6) /01/015 1/1/016 11/4/015 Page 6 of 186

63 KENOSHA COMMUNITY HEALTH CENTER, INC 456 ND AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner Lic #: 081 MICHAEL MIHAJLOVIC Initial Cert: 05/01/015 Phone: (6) /01/015 05/0/016 Fax: (6) /01/015 05/0/016 1 KENOSHA COMMUNITY HEALTH CENTER - 5ND ST. CLINIC, 10 5ND STREET, KENOSHA, WI /01/015 05/0/016 KENOSHA COMMUNITY HEALTH CENTER - 14TH AVE CLINIC, 66 14TH AVENUE, KENOSHA, WI /01/015 05/0/016 KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: SHERIDAN RD #100 KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATIE HANKS Initial Cert: 05/01/005 [email protected] Phone: (6) /01/015 04/0/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 05/01/015 04/0/017 KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), TH AVENUE, KENOSHA, WI /01/015 04/0/017 KENOSHA COUNTY DEPT OF HUMAN SERVICES/KENOSHA HUMAN DEVELOPMENT SERVICES INC Lic #: TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner KARI FOSS Initial Cert: 0/01/1977 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 KENOSHA HUMAN DEVELOPMENT SERVICES, INC Lic #: TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner TRACY FRENCH Initial Cert: 10/01/01 [email protected] Phone: (6) /01/015 09/0/016 Fax: (6) /01/015 09/0/016 KENOSHA HUMAN DEVELOPMENT SERVICES, INC COMMUNITY SUPPORT PROGRAM Lic #: TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner LISA A HAEN, MS Initial Cert: 01/01/010 [email protected] Phone: (6) /01/015 1/1/016 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/015 1/1/016 11/4/015 Page 6 of 186

64 MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. Lic #: SHERIDAN ROAD, # KENOSHA, WI 514 Kenosha County Surveyor: William Rohner TONY MOORE Initial Cert: 09/14/005 [email protected] Phone: (6) /01/015 09/0/017 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 OAKWOOD CLINICAL ASSOCIATES, LTD TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 08 AMY ANDERSON Initial Cert: 0/5/1991 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 OAKWOOD CLINICAL ASSOCIATES LTD, TH ST, PADDOCK LAKE, WI /01/014 0/9/016 PROFESSIONAL SERVICES GROUP, INC RD STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 1749 BRIAN WOLF Initial Cert: 06/01/198 [email protected] Phone: (6) /01/014 0/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 1 PROFESSIONAL SERVICES GROUP, 74 ELM STREET, WEST BEND, WI /01/014 0/1/016 1 PROFESSIONAL SERVICES GROUP, 800 GOOLD, RACINE, WI /9/014 0/1/016 PROFESSIONAL SERVICES GROUP, 116 S 70TH STREET # 508, WEST ALLIS, WI 514 PROFESSIONAL SERVICES GROUP, 116 S 70TH STREET, #11-, WEST ALLIS, WI 514 PROFESSIONAL SERVICES GROUP, 14 NORTH 8TH AVE, WEST BEND, WI 5095 PROFESSIONAL SERVICES GROUP, 565 MILWAUKEE AVE., BURLINGTON, WI /01/014 1/1/014 01/01/015 0/1/016 04/01/014 08/1/014 05/01/015 0/1/016 PSYCHIATRIC AND PSYCHOTHERAPY CLINIC 601-0TH AVENUE, #10 KENOSHA, WI 5144 Kenosha County Surveyor: William Rohner Lic #: 175 PAUL DEFAZIO Initial Cert: 06/01/1980 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 11/4/015 Page 64 of 186

65 ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM Lic #: TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner JODY PAHLAVAN PSY.D. Initial Cert: 04/8/00 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 Kewaunee County KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON, PHD Initial Cert: 0/01/1977 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County LAURA BORKOVETZ Initial Cert: 0/01/1977 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/015 01/1/017 KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON Initial Cert: 0/11/008 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 1/01/014 0/1/016 04/01/014 11/0/014 11/4/015 Page 65 of 186

66 La Crosse County COUNSELING ASSOCIATES LLC 115-5TH AVENUE SOUTH, #01 LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 80 MARIO EINSMAN Initial Cert: 06/05/008 Phone: (608) /01/015 05/1/016 Fax: (608) COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN /01/015 05/1/016 06/01/015 05/1/016 DRIFTLESS RECOVERY SERVICES INC Lic #: MAIN ST SUITE 01 LA CROSSE, WI La Crosse County Surveyor: Roderic Senn BRETT KNUTSON Initial Cert: 04/14/014 Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 FAMILY AND CHILDREN'S CENTER 1707 MAIN STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 115 VANESSA SOUTHWORTH Initial Cert: 0/01/1994 Phone: (608) /01/015 10/1/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 FAMILY AND CHILDREN'S CENTER, 11 NORTH MAIN ST, VIROQUA, WI /01/015 10/1/017 11/4/015 Page 66 of 186

67 GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH Lic #: SOUTH AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/1984 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1 GUNDERSEN CLINIC LTD,, ERVIN STREET, WHITEHALL, WI /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 6 NORTH ND STREET, LA CRESCENT, MN /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 805 MAIN AVE SOUTH, HARMONY, MN /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA /01/014 11/0/016 1 GUNDERSON CLINIC LTD, 5791 OSSEO ROAD, INDEPENDENCE, WI /01/014 11/0/016 1 GUNDERSON CLINIC LTD, 40 SOUTH PETERSON AVE, BLAIR, WI /01/014 11/0/016 1 LA CROSSE CO LAKEVIEW HEALTH CENTER, 90 GARLAND STREET, E, WEST SALEM, WI /01/014 11/0/016 1 RICHLAND MEDICAL CENTER, 01 EAST ND STREET, RICHLAND CENTER, WI /01/014 11/0/016 1 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI /01/014 11/0/016 GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 581 GUNDERSEN CLINIC, LTD, 180 STATE HWY 9, DECORAH, IA 5101 GUNDERSEN CLINIC, LTD, 601 N SUPERIOR, TOMAH, WI GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI GUNDERSEN LUTHERAN MEDICAL CENTER, 1-16TH AVE SOUTH, ONALASKA, WI GUNDERSEN LUTHERAN MEDICAL CENTER, 111 GUNDERSEN DRIVE, ONALASKA, WI /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH Lic #: SOUTH AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/198 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-NARCOTIC TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 1-16TH AVENUE SOUTH, ONALASKA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, ERVIN STREET, WHITEHALL, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 111 GUNDERSEN DRIVE, ONALASKA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 581 1/01/014 11/0/016 11/4/015 Page 67 of 186

68 LA CROSSE COUNTY HUMAN SERVICES 00 N 4TH STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 1488 BEV TRUSSONI Initial Cert: 0/01/1978 btrussoni@@lacrossecounty.org Phone: (608) /01/014 04/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 1 RAVENWOOD, 90 GARLAND ST. EAST, WEST SALEM, WI /01/015 04/0/016 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN HEALTHCARE Lic #: WEST AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn NAN ANDERSON Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 0/1/017 04/01/015 0/1/017 MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC Lic #: 16 1 S 11TH STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn LACIE ANTHONY Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 05/1/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS /01/015 05/1/017 06/01/015 05/1/017 06/01/015 05/1/017 06/01/015 10/04/015 MAYO CLINIC FRANCISCAN - ARCADIA, 464 SOUTH ST JOSEPH AVE, ARCADIA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 10 MAIN STREET, HOLMEN, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU CH 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SCARSETH HOUSE, 55 S 17TH STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - SIENA HALL, 608 S 11TH STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - SPARTA, 10 W. MAIN ST, SPARTA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - TOMAH, 5 BUTTS AVENUE, TOMAH, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - VILLA SUCCES, 11 PRAIRIE STREET, PRAIRIE DU CHIEN, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - WOMEN'S LAAR HOUSE, 1005 JACKSON STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 700 WEST AVENUE SOUTH, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI /01/015 05/1/017 11/4/015 Page 68 of 186

69 PEACE OF MIND COUNSELING 115-5TH AVENUE SOUTH, SUITE 507 LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 005 JAY CLARK Initial Cert: 08/01/01 Phone: (608) /01/014 07/1/016 Fax: 1 PEACE OF MIND CNSLNG - WINONA MN, 111 MARKET ST, SUITE 4A, WINONA, MN /01/014 07/1/016 08/01/014 0/8/015 PEACE OF MIND CNSLNG - WINONA MN, 90 E. ND ST., STE., WINONA, MN CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI COCHRANE-FOUNTAIN CITY SCHOOL DISTRICT, S770 STATE HIGHWAY 5, FOUNTAIN CITY, WI 546 COULEE REGION ALTERNATIVE SCHOOL, 087 COLLEGE AVENUE, GALESVILLE, WI 5460 EMERSON ELEMENTARY SCHOOL, 101 CAMPBELL ROAD, LA CROSSE, WI EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 5466 G-E-T ELEMENTARY SCHOOL - GALESVILLE, FRENCH RD, GALESVILLE, WI 5460 G-E-T HIGH SCHOOL, NORTH MAIN ST, GALESVILLE, WI 5460 G-E-T MIDDLE SCHOOL, PRAIRIE RIDGE LANE, GALESVILLE, WI 5460 HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI HOLMEN HIGH SCHOOL, 1001 MCHUGH ROAD, HOLMEN, WI 5466 HOLMEN MIDDLE SCHOOL, 50 N MAIN STREET, HOLMEN, WI 5466 LA CRESCENT ELEMENTARY, 504 SOUTH OAK STREET, LA CRESCENT, MN LA CRESCENT MS/HS, 101 LANCER BLVD, LA CRESCENT, MN ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI PEACE OF MIND COUNSELING, LLC, 99 MILWAUKEE STREET, LA CROSSE, WI 5460 PRAIRIE VIEW ELEMENTARY, 101 NEWPORT LANE, HOLMEN, WI 5466 SAND LAKE ELEMENTARY, 600 SAND LAKE ROAD, HOLMEN, WI 5466 STODDARD ELEMENTARY SCHOOL, 00 N. COTTAGE ST., STODDARD, WI VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI /01/015 07/1/016 08/01/014 07/1/016 11/1/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 05/1/016 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 0/0/016 07/1/016 08/01/014 07/1/016 WESTERN REGION INTEGRATED CARE CCS 00-4TH STREET NORTH LA CROSSE, WI 5460 La Crosse County Surveyor: Roderic Senn Lic #: 044 CHRISTIN SKOLNIK Initial Cert: 07/04/014 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 07/01/015 06/0/016 JACKSON COUNTY HUMAN SERVICES - CCS, 40 COUNTY HWY 54 POX 457, BLACK RIVER FALLS, WI 07/01/015 06/0/016 MONROE COUNTY HUMAN SERVICES CCS, 1401 COUNTY HWY B, SPARTA, WI /01/015 06/0/016 11/4/015 Page 69 of 186

70 WESTERN REGION INTEGRATED CARE CONSORTIUM (WRIC) CSP Lic #: MAIN STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn KATHY ROHR Initial Cert: 11/01/014 Phone: (608) /01/015 1/1/015 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/015 1/1/015 1 FAMILY & CHILDREN'S CENTER, MONROE SITE, 1401 COUNTY HIGHWAY B, SPARTA, WI /01/015 09/14/015 FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 1 MAIN ST., STE. L101, BLACK RIVER F FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 409 COUNTY RD R, BLACK RIVER FALLS FAMILY & CHILDREN'S CENTER, MONROE COUNTY OFFICE, 90 WEST WISCONSIN, SPARTA, WI /16/015 1/1/015 01/01/015 0/15/015 01/01/015 1/1/015 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH Lic #: TH AVENUE, SOUTH ONALASKA, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/000 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 LIVING WELL CHRISTIAN FAMILY CLINIC, LLC 575 LESTER AVENUE STE #100 ONALASKA, WI La Crosse County Surveyor: Roderic Senn Lic #: 778 PHILIP KOESTLER Initial Cert: 04/01/008 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 STEIN COUNSELING AND CONSULTING SERVICES, LTD Lic #: BRAUND STREET ONALASKA, WI La Crosse County Surveyor: Roderic Senn TED STEIN Initial Cert: 08/06/00 [email protected] Phone: (608) /01/015 08/1/017 Fax: (608) EAGLE BLUFF ELEMENTARY, 00 EAGLE BLUFF COURT, ONALASKA, WI NORTHERN HILLS ELEMENTARY, 511 SPRUCE ST, ONALASKA, WI ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 11/4/015 Page 70 of 186

71 Lafayette County LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: N MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/015 10/1/017 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: N MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 11/01/000 [email protected] Phone: (608) /01/015 10/1/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/016 Langlade County LANGLADE HOSPITAL GENERAL CLINIC 110 E FIFTH AVENUE ANTIGO, WI Langlade County Surveyor: Polly Wong Lic #: 890 SYLVIA DENNISON MD Initial Cert: 07/7/010 [email protected] Phone: (715) /01/015 07/1/017 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 ASPIRUS ELCHO CLINIC, W10618 CLINIC DR, ELCHO, WI /0/016 07/1/017 WETZEL-RASMUSSEN COUNSELING SERVICES N110 ANTIGO STREET ELCHO, WI 5448 Langlade County Surveyor: Polly Wong Lic #: 5 NATALIE WETZEL-RASMUSSEN Initial Cert: 07/01/004 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) /01/015 06/0/017 11/4/015 Page 71 of 186

72 Lincoln County ANDERSON & ASSOCIATES COUNSELING AND PSYCHOLOGIST SERVICES Lic #: EAST SECOND ST MERRILL, WI 5445 Lincoln County Surveyor: Polly Wong BREEZY BONNEVILLE Initial Cert: 04/01/004 Phone: (715) /01/015 0/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 PSYCHOLOGICAL RESOURCE CENTER, LLC 118 N 4TH STREET, #108 TOMAHAWK, WI Lincoln County Surveyor: Polly Wong Lic #: 806 ELIZABETH K MCCLUSKEY Initial Cert: 10/01/008 [email protected] Phone: (715) /01/014 09/0/016 Fax: (715) /01/014 09/0/016 1 FOREST COUNTY COURTHOUSE, 00 EAST MADISON STREET, CRANDON, WI /5/014 09/0/016 TOMAHAWK SCHOOLS, 1048 EAST KING RD, TOMAHAWK, WI /01/014 09/0/016 11/4/015 Page 7 of 186

73 Manitowoc County MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT Lic #: S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 Phone: (90) /01/015 10/1/017 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT CSP Lic #: S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/015 10/1/017 Fax: (90) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 11/01/015 10/1/017 MANITOWOC COUNTY HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: S. 8TH STREET MANITOWOC, WI 541 Manitowoc County JEFF JENSWOLD Initial Cert: 0/06/007 [email protected] Phone: (90) /01/015 0/9/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC 115 E. WALDO BOULEVARD MANITOWOC, WI 540 Manitowoc County Lic #: 1591 TODD EIDEN, PHD Initial Cert: 08/6/1991 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 110 LINCOLN ST, WISCONSIN RAPIDS, WI /5/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 111 NORTH 7TH STREET, SHEBOYGAN, WI /01/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 807 CENTER STREET, SHEBOYGAN, WI /01/014 1/1/014 11/4/015 Page 7 of 186

74 AURORA BEHAVIORAL HEALTH CENTER - MANITOWOC Lic #: MEMORIAL DRIVE TWO RIVERS, WI 5441 Manitowoc County TRACY LINDBERG Initial Cert: 09/01/199 [email protected] Phone: (90) /01/014 0/1/016 Fax: (608) /01/014 0/1/016 11/4/015 Page 74 of 186

75 Marathon County COURAGE TO CHANGE RECOVERY 106 GALVIN ROAD ABBOTSFORD, WI Marathon County Surveyor: Polly Wong Lic #: 180 RAE ANN WICHLACZ Initial Cert: 01/07/000 Phone: (715) /01/015 10/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 10/1/017 11/01/015 10/1/017 1 COURAGE TO CHANGE RECOVERY, 880 E PERKINS, #10, MEDFORD, WI /01/015 10/1/017 COURAGE TO CHANGE RECOVERY, 188 N LAKE AVENUE, PO BOX, PHILLIPS, WI CHEQUAMEGON HIGH SCHOOL, 400 9TH STREET, NORTH, PARK FALLS, WI /01/015 10/1/017 11/01/015 10/1/017 ACHIEVE CENTER 50 NORTH 8TH AVE, #00 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 719 CAROL WESLEY Initial Cert: 04/01/007 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 CENTER FOR HUMAN DEVELOPMENT 61 FOREST STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 115 RUTH HEBBE Initial Cert: 1/01/1996 [email protected] Phone: (715) /01/015 11/0/017 Fax: (715) CENTER FOR HUMAN DEVELOPMENT INC, 1509 N FOURTH ST, SUITE, TOMAHAWK, WI CENTER FOR HUMAN DEVELOPMENT, 417 POST ROAD, SUITE H, STEVENS POINT, WI CENTER FOR HUMAN DEVELOPMENT, 4 S CENTRAL STREET, #109, MARSHFIELD, WI /01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 TOMAHAWK ELEMENTARY, MIDDLE & HIGH SCHOOL, 1048 E. KING RD, TOMAHAWK, WI /01/015 11/0/017 CHARIS COUNSELING, LLC 60 W. STEWART AVENUE, #10 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 464 LORI THOMPSON Initial Cert: 09/01/00 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/18/016 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 CHARIS COUNSELING, LLC, 101 W MC MILLAN STREET, #B, MARSHFIELD, WI /01/014 08/1/016 11/4/015 Page 75 of 186

76 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 705 S. 4TH AVENUE, #40 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 1185 GRETCHEN HINTZ Initial Cert: 1/01/198 Phone: (715) /01/014 1/1/015 Fax: (715) /01/014 1/1/015 CHILDREN'S SERVICE SOCIETY OF WI-MARSHFIELD, 601 S CENTRAL AVENUE, #00, MARSHFIELD, W 01/01/014 1/1/015 CHILDREN'S SERVICE SOCIETY OF WI-STEVENS PT, 101 WATER STREET, # C, STEVENS POINT, WI 01/01/014 04/5/014 CHILDREN'S SERVICE SOCIETY OF WI-STEVENS PT, 1466 WATER STREET, STEVENS POINT, WI /9/014 1/1/015 JEFFERSON ELEMENTARY, 1800 EAST AVE, STEVENS POINT, WI MADISON ELEMENTARY, 600 MARIA DRIVE, STEVENS POINT, WI MARSHFIELD HIGH SCHOOL, 1401 EAST BECKER ROAD, MARSHFIELD, WI MCDILL ELEMENTARY, 516 SCHOOL STREET, STEVENS POINT, WI MCKINLEY ELEMENTARY, 96 BLAINE STREET, STEVENS POINT, WI NEILLSVILLE ELEMENTARY SCHOOL, 504 EAST FIFTH STREET, NEILLSVILLE, WI NEILLSVILLE HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI /15/014 1/1/015 10/15/014 1/1/015 0/0/017 1/1/015 10/05/016 1/1/015 10/15/014 1/1/015 0/04/015 1/1/015 0/04/015 1/1/015 COMPASS COUNSELING WAUSAU, LLC 50 GRANT STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 99 TRACY PETERSON Initial Cert: 0/5/011 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU LLC, 19 SUPERIOR ST, ANTIGO, WI /01/014 1/1/014 1 COMPASS COUNSELING WAUSAU LLC, 60 E WALL STREET, EAGLE RIVER, WI /01/014 0/1/015 1 COMPASS COUNSELING WAUSAU, LLC, 1004 FIRST ST, STE, STEVENS POINT, WI /0/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 50 8TH ST S, WISCONSIN RAPIDS, WI /01/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 86 S. SUPERIOR ST., STE 109, ANTIGO, WI /0/015 0/1/016 ADAMS FRIENDSHIP ELEMENTARY, 500 N PIERCE ST, ADAMS, WI 5910 ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 5910 ADAMS FRIENDSHIP MIDDLE SCHOOL, 40 N MAIN ST, ADAMS, WI /19/014 0/1/016 09/19/014 0/1/016 09/19/014 0/1/016 DIX & GILLETTE COUNSELING SERVICES, LLP 170 MERRILL AVE SUITE 401 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 49 MICHAEL DIX Initial Cert: 0/01/001 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 01/1/016 0/01/014 01/1/016 11/4/015 Page 76 of 186

77 ELMERGREEN ASSOCIATES, INC. 114 GRAND AVENUE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 199 DENNIS ELMERGREEN Initial Cert: 11/05/199 Phone: (715) /01/015 10/1/017 Fax: (715) /01/015 10/1/017 1 ELMERGREEN ASSOCIATES, 11 N. MAIN STREET, MARION, WI /01/015 10/1/017 ELMERGREEN ASSOCIATES, INC, 607 E ELIZABETH STREET, SHAWANO, WI /01/015 10/1/017 NORTH CENTRAL HEALTH CARE 1100 LAKE VIEW DRIVE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 1677 AEKTA DASSOW Initial Cert: 10/01/1975 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) CSAS-AMBULATORY DETOXIFICATION DHS CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 07/0/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 ANTIGO CENTER, 15 LANGLADE ROAD, ANTIGO, WI /01/015 0/8/017 MERRILL CENTER, 607 N SALES STREET, #09, MERRILL, WI /01/015 0/8/017 TOMAHAWK OFFICE, 1 WEST WISCONSIN AVE, TOMAHAWK, WI /01/015 0/8/017 NORTH CENTRAL HEALTH CARE CCS 1100 LAKE VIEW DRIVE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 041 ERICA HUFFMAN Initial Cert: 07/01/014 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CCS REGIONAL MODEL UNIFIED BOARD DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 15 LANGLADE ROAD, ANTIGO, WI /01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LINCOLN COUNTY, 607 NORTH SALES ST. SUITE 09, MERRILL, WI 01/01/015 1/1/016 11/4/015 Page 77 of 186

78 NORTH CENTRAL HEALTH CARE CSP 1100 LAKE VIEW DRIVE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 97 ERICA HUFFMAN Initial Cert: 10/01/1975 Phone: (715) /01/015 1/1/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE CSP - LANGLADE, 15 LANGLADE ROAD, ANTIGO, WI /01/015 1/1/016 NORTH CENTRAL HEALTH CARE CSP - LINCOLN, 607 N. SALES STREET SUITE 09, MERRILL, WI /01/015 1/1/016 NORTHWEST JOURNEY - WAUSAU 5655 N 8TH AVENUE WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 404 AMY MARTHALER Initial Cert: 09/18/00 [email protected] Phone: (715) /09/015 01/1/017 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 11/09/015 01/1/017 11/09/015 01/1/017 PEACEFUL SOLUTIONS COUNSELING 741 NORTH 1ST STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 715 LEE SHIPWAY Initial Cert: 0/01/007 [email protected] Phone: (715) /01/014 0/9/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 1 PEACEFUL SOLUTIONS COUNSELING, 76 EAST ND STREET, MERRILL, WI /01/014 0/9/016 EDGAR MIDDLE/HIGH SCHOOL, 0 E. BIRCH STREET, EDGAR, WI /5/015 0/9/016 PRIMARY CONNECTION HEALTH CARE, INC. DBA BRIDGE COMMUNITY HEALTH CLINIC Lic #: N SECOND STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong JENNIFER SMITH Initial Cert: 08/01/009 [email protected] Phone: (715) /01/014 07/1/016 Fax: (715) /01/014 07/1/016 1 ASPIRUS WESTON CLINIC, 4005 COMMUNITY CENTER DRIVE, WESTON, WI /01/014 07/1/016 1 BRIDGE ASPIRUS BEHAV MED CLINIC, 500 FOREST STREET, WAUSAU, WI /01/014 07/1/016 11/4/015 Page 78 of 186

79 THE CENTRE FOR WELL-BEING, INC. 901 N 6TH STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 1909 NOREEN SALZMAN Initial Cert: 0/17/199 [email protected] Phone: (715) /01/015 08/1/017 Fax: (888) CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 1415 EAGLE STREET, RHINELANDER, WI /01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 01 N CENTER AVE, MERRILL, WI /01/015 08/1/017 LAC DU FLAMBEAU ELEMENTARY SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI /01/015 08/1/017 ASPIRUS BEHAVIORAL MEDICINE CLINIC 4005 COMMUNITY CENTER DRIVE WESTON, WI Marathon County Surveyor: Polly Wong Lic #: 75 PAMELA HOFF Initial Cert: 0/01/007 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/015 0/8/017 0/01/015 0/8/017 ASPIRUS BEHAVIORAL MEDICINE CLINIC, 45 PINE RIDGE BLVD, #05B, WAUSAU, WI /01/015 0/8/017 11/4/015 Page 79 of 186

80 Marinette County MARINETTE AND OCONTO COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: HALL AVE MARINETTE, WI 5414 Marinette County JESSICA BEAUCHAMP Initial Cert: 10/01/015 Phone: (715) /01/015 09/0/016 Fax: (715) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 6 10/01/015 09/0/016 10/01/015 09/0/016 1 OCONTO COUNTY DEPT. OF HEALTH AND HUMAN SERVICES, 501 PARK AVE., OCONTO, WI /01/015 09/0/016 MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT Lic #: HALL AVENUE MARINETTE, WI 5414 Marinette County ROBERT VALENTINE Initial Cert: 01/01/198 [email protected] Phone: (715) /01/015 11/0/017 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 MARINETTE COUNTY HHSD/ADAPT, 101 JACKSON STREET, NIAGARA, WI /01/015 11/0/017 MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT CSP Lic #: HALL AVENUE, #A MARINETTE, WI 5414 Marinette County CANDACE BREAULT Initial Cert: 01/01/198 [email protected] Phone: (715) /01/015 11/0/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page 80 of 186

81 Marquette County MARQUETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: UNDERWOOD AVE MONTELLO, WI 5949 Marquette County MANDY STANLEY Initial Cert: 01/1/015 [email protected] Phone: (608) /01/015 11/0/015 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 11/0/015 NORTHLAND COMMUNITY SERVICES 161 SPRING STREET WESTFIELD, WI 5964 Marquette County Lic #: 169 DR JON MATTHEW Initial Cert: 01/01/198 [email protected] Phone: (608) /01/015 10/1/016 Fax: (608) /01/015 10/1/016 1 NORTHLAND COMMUNITY SERVICES, 19 S MAIN, PO BOX 1178, ADAMS, WI /01/015 10/1/016 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM Lic #: SPRING STREET WESTFIELD, WI 5964 Marquette County DR JON MATTHEW Initial Cert: 01/01/198 [email protected] Phone: (608) /01/01 10/1/015 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/01 10/1/015 11/4/015 Page 81 of 186

82 Menominee County MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT Lic #: 1587 W7 WOLF RIVER ROAD KESHENA, WI 5415 Menominee County AMY ZIMMER Initial Cert: 11/01/1994 Phone: (715) /01/015 04/0/017 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT CSP Lic #: 8 W7 WOLF RIVER ROAD KESHENA, WI 5415 Menominee County RACHEL KIELBLOCK Initial Cert: 11/01/1994 [email protected] Phone: (715) /01/015 04/0/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/017 MENOMINEE TRIBAL CLINIC, BEHAVIORAL HEALTH SERVICES Lic #: 1588 W75 WOLF RIVER DRIVE KESHENA, WI 5415 Menominee County STEPHEN EISFELDER Initial Cert: 0/0/199 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) /01/015 0/8/017 11/4/015 Page 8 of 186

83 REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC Lic #: W BRADLEY ROAD BROWN DEER, WI 5 CANDICE LIPSKI Initial Cert: 09/01/009 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT Lic #: W SCHROEDER DRIVE BROWN DEER, WI 5 Surveyor: Merrilee Follensbee JESSICA PITRE Initial Cert: 07/1/004 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 ROGERS MEMORIAL HOSPITAL, INC 4600 WEST SCHROEDER DRIVE BROWN DEER, WI 5 Lic #: 084 JAMES KUBICEK Initial Cert: 04/8/015 Phone: (414) /8/015 0/1/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /8/015 0/1/016 04/8/015 0/1/016 04/8/015 0/1/016 04/8/015 0/1/016 AURORA HEALTH CARE METRO, INC. DBA AURORA ST. LUKE'S SOUTH SHORE Lic #: S. LAKE DRIVE CUDAHY, WI 5110 NORMAN SHANKS Initial Cert: 11/01/1989 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 09/0/016 07/09/015 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 11/4/015 Page 8 of 186

84 AURORA BEHAVIORAL HEALTH - FRANKLIN 900 W. LOOMIS ROAD, #17 FRANKLIN, WI 51 Lic #: 1650 KATHERINE CONNELLY Initial Cert: 05/0/1994 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 04/0/017 05/01/015 04/0/017 1 AURORA BEHAVIORAL HEALTH CENTER - MOORLAND, S68W15500 JANESVILLE RD, MUSKEGO, WI 5 05/01/015 04/0/017 AURORA BEHAVIORAL HEALTH CENTER - LAYTON, 000 E. LAYTON AVE., STE 50, SAINT FRANCIS, W AURORA BEHAVIORAL HEALTH CENTER-LAKESHORE, 611 CHICAGO AVE, SOUTH MILWAUKEE, WI 5 05/01/015 04/0/017 05/01/015 04/0/017 PERFORMANCE ENHANCEMENT HEALTH SERVICES, SC Lic #: SOUTH 10ND ST #10 FRANKLIN, WI 51 Surveyor: Merrilee Follensbee JODI PETERNEL Initial Cert: 0/11/1991 [email protected] Phone: (414) /01/014 01/1/016 Fax: (414) /01/014 01/1/016 1 PERFORMANCE ENHANCEMENT HEALTH SERVICES SC, 7418 N TICHIGAN RD, WATERFORD, WI 518 0/01/014 01/1/016 ALLIANCE INDIVIDUAL & FAMILY SERVICES LLC 500 W SILVER SPRING DR, STE 00 GLENDALE, WI 517 Lic #: 975 ALFREDA MITCHELL Initial Cert: 08/01/01 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) /01/015 07/1/017 GREENSQUARE DEVELOPMENTAL SPECIALISTS Lic #: N GREEN BAY ROAD GLENDALE, WI 509 TRACY CLEMENS Initial Cert: 08/17/007 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) /01/014 07/1/016 GREENSQUARE DEVELOPMENTAL SPECIALISTS, 700 SOUTH 1TH STREET, OAK CREEK, WI /01/014 07/1/016 11/4/015 Page 84 of 186

85 NORTH SHORE PSYCHOTHERAPY ASSOCIATES 5800 N BAYSHORE DRIVE #A50 GLENDALE, WI 517 Surveyor: Merrilee Follensbee Lic #: 168 DANIELA JARAMILLO Initial Cert: 07/01/1980 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) /01/014 09/0/016 SHOREHAVEN BEHAVIORAL HEALTH INC 900 W BROWN DEER ROAD #00 GLENDALE, WI 509 Lic #: 186 LYNN GODEC Initial Cert: 07/01/198 [email protected] Phone: (414) /01/014 06/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH INC, 77 W CLEVELAND AVE, MILWAUKEE, WI /01/014 06/01/015 SHOREHAVEN BEHAVIORAL HEALTH INC, 470 SOUTH 76TH STREET, GREENFIELD, WI 50 07/01/014 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 607 N GRANDVIEW BLVD., # 10, WAUKESHA, WI /01/015 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 6 DURAND AVE #F, RACINE, WI /01/014 06/0/016 STRESS MANAGEMENT & MENTAL HEALTH CLINICS Lic #: N. IRONWOOD LANE, #10 GLENDALE, WI 517 DR. CRAIG MODELL Initial Cert: 10/01/1997 [email protected] Phone: (414) /01/014 0/1/016 Fax: (414) /01/014 0/1/016 BELL THERAPY COMMUNITY SUPPORT PROGRAM SOUTH Lic #: SOUTH 108TH STREET GREENFIELD, WI 58 DOUGLAS HIGBIE Initial Cert: 0/0/1997 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) 8-45 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 08/01/015 07/1/017 11/4/015 Page 85 of 186

86 16TH STREET BEHAVIORAL HEALTH CENTER 10 S. 16TH STREET MILWAUKEE, WI 504 Lic #: 1011 MARIA PEREZ Initial Cert: 10/15/1997 Phone: (414) /01/014 10/1/016 Fax: (414) /01/014 10/1/016 1 PARKWAY CLINIC, 906 S 0TH STREET, MILWAUKEE, WI /01/014 10/1/016 1 WAUKESHA COMMUNITY HEALTH CENTER, 09 E. NORTH STREET, WAUKESHA, WI /01/014 10/1/016 A STRONG FOUNDATION COUNSELING SERVICES, LLC Lic #: N OAKLAND AVENUE MILWAUKEE, WI 511 NEAOKIA COLLINS Initial Cert: 11/06/01 [email protected] Phone: (414) /01/015 10/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 10/1/016 1/01/015 10/1/016 1/01/015 10/1/016 ACACIA MENTAL HEALTH CLINIC, LLC 58 W FOND DU LAC AVE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee Lic #: 1006 ABE FREUND Initial Cert: 10/01/199 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 1645 N. FARWELL ST., SUITE 0, MILWAUKEE, WI 50 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 91 S KINNICKINNIC AVENUE, MILWAUKEE, WI /01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 6040 WEST LISBON AVE STE #10, MILWAUKEE, WI /01/015 07/1/017 ACHIEVEMENT ASSOCIATES, LTD WEST BLUEMOUND RD MILWAUKEE, WI 56 Lic #: 1010 NEENA FLORSHEIM Initial Cert: 07/01/199 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/015 05/1/017 06/01/015 05/1/017 11/4/015 Page 86 of 186

87 ADKINS COUNSELING SERVICES 6001 W CENTER STREET #105 MILWAUKEE, WI 510 Lic #: 844 MARCELLA ADKINS Initial Cert: 01//009 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) /01/014 1/1/015 AIDS RESOURCE CENTER OF WISCONSIN 80 N. PLANKINTON AVENUE MILWAUKEE, WI 50 Lic #: 406 KEVIN ROEDER Initial Cert: 10/0/00 [email protected] Phone: (414) /01/015 1/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 1/0/016 01/01/015 1/0/016 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-KENOSHA, 11-57TH STREET, KENOSHA, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-LA CROSSE, 505 KING STREET, LA CROSSE, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WISCONSIN, 6 C WEST WISCONSIN AVE, APPLETON, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI /01/015 1/0/016 1 AIDS RESOURCE ENTER OF WI-EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI /01/015 1/0/016 1 ARCW, 16 W. GRAND AVENUE, BELOIT, WI /01/015 1/0/016 1 ARCW, 600 WILLIAMS STREET, MADISON, WI 570 0/01/015 1/0/016 AIDS RESOURCE CENTER OF WI-GREEN BAY, 445 S ADAMS STREET, GREEN BAY, WI /01/015 1/0/016 AMRI COUNSELING SERVICES, LLC 4001 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 875 LAKEIA JONES Initial Cert: 08/01/009 [email protected] Phone: (414) /01/014 07/1/016 Fax: (866) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 1 AMRI COUNSELING SERVICES, 1 6RD ST, KENOSHA, WI /9/014 07/1/016 11/4/015 Page 87 of 186

88 AURORA BEHAVIORAL HEALTH - NORTH SHORE Lic #: N. PORT WASHINGTON, #0 MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 08/01/1985 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 1 AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER STREET, HARTFORD, WI /01/014 07/1/016 AURORA BEHAVIORAL HEALTH - GRAFTON, 975 N. PORT WASHINGTON RD, GRAFTON, WI 504 AURORA BEHAVIORAL HEALTH - WEST BEND, 05 VALLEY AVENUE, WEST BEND, WI /01/014 07/1/016 08/01/014 07/1/016 AURORA BEHAVIORAL HEALTH CENTER - SINAI 100 N 1TH ST 4TH FLOOR MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 189 KATE CONNELLY Initial Cert: 10/01/1987 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 AURORA FAMILY SERVICE, INC. 00 W HIGHLAND BOULEVARD MILWAUKEE, WI 508 Lic #: 16 ROBERT MARRS Initial Cert: 05/01/1977 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) /01/014 07/1/016 AUDUBON TECHNOLOGY AND COMMUNICATION CENTER, 00 S. 9TH STREET, MILWAUKEE, WI 5 11/18/016 07/1/016 CROSS TRAINERS ACADEMY, 1516 W. CENTER STREET, MILWAUKEE, WI 5 11/18/016 07/1/016 FOREST HOME ELEMENTARY SCHOOL, 1516 W. FOREST HOME, MILWAUKEE, WI /18/016 07/1/016 HOPKINS LLOYD COMMUNITY SCHOOL, 150 W. HOPKINS STREET, MILWAUKEE, WI /18/016 07/1/016 KAGEL ELEMENTARY SCHOOL, 110 W. MINERAL STREET, MILWAUKEE, WI /18/016 07/1/016 NEXT DOOR FOUNDATION, 545 N. 9TH STREET, MILWAUKEE, WI /18/016 07/1/016 WEST SIDE ACADEMY, 1945 N. 1ST STREET, MILWAUKEE, WI /18/016 07/1/016 BELL THERAPY SOUTH 68TH STREET 858 SOUTH 68TH STREET MILWAUKEE, WI 519 Lic #: 5 JILL LETIZIA Initial Cert: 07/01/000 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) MENTAL HEALTH-DAY TREATMENT DHS /01/014 07/1/016 11/4/015 Page 88 of 186

89 BELL THERAPY INC DAY ONE 4065 N 5TH STREET MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee Lic #: 1096 JILL LETIZIA Initial Cert: 10/01/1987 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) MENTAL HEALTH-DAY TREATMENT DHS /01/015 0/1/017 BELL THERAPY INC COMMUNITY SUPPORT PROGRAM NORTH Lic #: W FOND DU LAC AVENUE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee DOUG HIGBIE Initial Cert: 09/01/1990 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM Lic #: W WELLS STREET, #700 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee JOAN KOJIS Initial Cert: 01/15/00 [email protected] Phone: (414) /01/016 1/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/016 1/1/017 01/01/016 1/1/017 CAREER YOUTH DEVELOPMENT, INC. 60 N. MARTIN LUTHER KING DR. MILWAUKEE, WI 51 Lic #: 117 STERLON WHITE Initial Cert: 0/15/199 [email protected] Phone: (414) /01/015 05/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 05/1/016 06/01/015 05/1/016 06/01/015 05/1/016 CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. Lic #: N. 60TH STREET MILWAUKEE, WI 508 Surveyor: Merrilee Follensbee MANDY BIBO Initial Cert: 06/01/1981 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 11/4/015 Page 89 of 186

90 CENTER FOR QUALITY COMMUNITY LIFE, INC. (CQCL) Lic #: W VILLARD AVENUE, #00 MILWAUKEE, WI 518 KATHY CARTER Initial Cert: 08/01/01 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 CHILD, ADOLESCENT, FAMILY & MARRIAGE THERAPY ASSOCIATES Lic #: W WELLS ST, STE 60 MILWAUKEE, WI 50 EMMA WILLIAMS Initial Cert: 0/01/1995 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) /01/015 0/1/017 CHILDREN'S HOSPITAL OF MILWAUKEE 100 N. 1TH STREET, 5TH FLOOR MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 417 LYNN WOLF Initial Cert: 01//00 [email protected] Phone: (414) /01/015 1/1/016 Fax: (414) /01/015 1/1/016 CHILDREN'S HOSPITAL OF WISCONSIN 9000 W. WISCONSIN AVENUE MILWAUKEE, WI 56 Lic #: 1179 LYNN WOLF Initial Cert: 10/01/1978 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/014 11/0/016 1/01/014 11/0/016 1 CHILDREN'S HOSP OF WI CLINICS - NEW BERLIN, 4855 S MOORLAND ROAD, NEW BERLIN, WI /01/014 11/0/016 11/4/015 Page 90 of 186

91 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 60 S 76TH SREET, #10 MILWAUKEE, WI 514 Surveyor: Merrilee Follensbee Lic #: 1187 ANN ROLLING Initial Cert: 01/01/198 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) GREATER HOLY TEMPLE CHRISTIAN ACADEMY, 5575 NORTH 76TH STREET, MILWAUKEE, WI 518 PIERCE ELEMENTARY SCHOOL, 764 N. FRATNEY STREET, MILWAUKEE, WI 51 01/01/014 1/1/015 09/14/015 1/1/015 09/14/015 1/1/015 COLUMBIA ST. MARY'S BEHAVIORAL MEDICINE - MILWAUKEE Lic #: 1870 N LAKE DRIVE, 7TH FLOOR MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM FRY Initial Cert: 06/01/1981 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE CAMPUS Lic #: N LAKE DRIVE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM L. FRY Initial Cert: 07/01/015 [email protected] Phone: (414) /01/015 06/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 06/0/016 07/01/015 06/0/016 COMPREHENSIVE CLINICAL & CONSULTING SERVICES INC Lic #: N PORT WASHINGTON RD MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee JESSICA JARDAS Initial Cert: 01/01/198 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) /01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 1616 NORTH CASALOMA DR, APPLETON, WI /01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 595 DEVELOPMENT DRIVE, GREEN BAY, WI /01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 9697 ST CATHERINE'S DRIVE, PLEASANT PRAIRIE, WI /01/014 08/1/016 1 COMPREHENSIVE CLINICAL & CONSULTING SVS, 416 OLD GREEN BAY ROAD, RACINE, WI /01/014 08/1/016 COMPREHENSIVE CLINICAL & CONSULTING SVS, 411 W LOOMIS RD SUITE 40, GREENFIELD, WI 5 09/01/014 08/1/016 11/4/015 Page 91 of 186

92 DLO PARTNERS LLC DBA BRIGHTSIDE MENTAL HEALTH Lic #: S CHASE AVE MILWAUKEE, WI 507 JEFF SCHULZ Initial Cert: 0/01/014 [email protected] Phone: (414) /01/015 0/9/016 Fax: (414) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/015 0/9/016 0/01/015 0/9/016 1 CHURCH SETTING AT FIRST UNITED METHODIST CHURCH, 11 WISCONSIN AVE, ROOM 14, WAUKES 0/01/015 0/9/016 EBB TIDE THERAPY 81 N 4TH STREET RM 144 MILWAUKEE, WI 51 Lic #: 956 SHANNON O'BRIEN Initial Cert: 0/01/01 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) 7-71 CSAS-OUTPATIENT TREATMENT DHS /01/015 01/1/017 0/01/015 01/1/017 EMPATHETIC COUNSELING SERVICES INC W BURLEIGH ST MILWAUKEE, WI 510 Lic #: 95 TANYA BROUGHTON LEWIS Initial Cert: 1/01/011 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) -5 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/015 1/01/014 11/0/016 1/01/014 11/0/016 1 EMPATHETIC COUNSELING SERVICES SOUTH, 551 WEST HISTORIC MITCHELL ST, MILWAUKEE, WI 5 1/01/014 11/0/016 FOKUS FAMILY SERVICES 81 N. 4TH STREET, #19 MILWAUKEE, WI 51 Lic #: 47 ELZORA COLLINS Initial Cert: 0/01/014 [email protected] Phone: (414) /01/014 0/9/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 0/8/015 04/01/014 0/9/016 04/01/014 0/9/016 11/4/015 Page 9 of 186

93 FORWARD CHOICES LLC 6040 W LISBON AVENUE, #10 MILWAUKEE, WI 510 Surveyor: Merrilee Follensbee Lic #: 785 MICHAEL WALLNER Initial Cert: 05/14/008 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 GATEWAY TO CHANGE 19 W. CAPITOL DRIVE MILWAUKEE, WI 506 Lic #: 479 GLENDA HAMPTON Initial Cert: 10/9/00 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GENESIS MILWAUKEE OUTPATIENT CLINIC 0 W WELLS STREET, #1 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 177 GINA SINGLETERY Initial Cert: 1/01/1987 [email protected] Phone: (414) /01/015 11/0/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 GERALD L IGNACE INDIAN HEALTH CENTER 1711 SOUTH 11TH STREET MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 040 LYLE IGNACE Initial Cert: 08/01/014 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 11/4/015 Page 9 of 186

94 GRO FAMILY SERVICES 6400 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 80 GREGORY OWENS Initial Cert: 08/8/008 Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 GRO FAMILY SERVICES II, 55 WEST CAPITOL DRIVE, MILWAUKEE, WI /01/015 07/1/017 GUEST HOUSE COUNSELING CLINIC 116 N. 1TH STREET MILWAUKEE, WI 505 Surveyor: Merrilee Follensbee Lic #: 101 KRISTEN VAREKA Initial Cert: 07/15/199 Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 HORIZON HEALTHCARE INC 4650 S HOWELL AVENUE MILWAUKEE, WI 507 Lic #: 174 EMILY HILL Initial Cert: 11/01/1999 [email protected] Phone: (414) /01/015 11/0/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 HORIZON HEALTHCARE, INC, 5408 W BURLEIGH ST, MILWAUKEE, WI 510 1/01/015 11/0/017 INNER CITY BEHAVIORAL SERVICES, LLC 7514 W APPLETON AVENUE SUITE 4 MILWAUKEE, WI 516 Lic #: 087 BARBARA TRIPP Initial Cert: 04/01/015 [email protected] Phone: (414) /01/015 0/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/016 04/01/015 0/1/016 11/4/015 Page 94 of 186

95 JEWISH FAMILY SERVICES 100 N JACKSON STREET MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 1450 RACHEL NELSON Initial Cert: 06/01/1979 [email protected] Phone: (414) /01/014 05/1/016 Fax: (414) CHAI POINT, 1400 NORTH PROSPECT AVENUE, MILWAUKEE, WI 50 1 JEWISH FAMILY SVS - BRADLEY CROSSING, 475 WEST BRADLEY ROAD, BROWN DEER, WI 5 1 JEWISH HOME AND CARE CENTER, INC., 1414 NORTH PROSPECT AVENUE, MILWAUKEE, WI 50 06/01/014 05/1/016 08/19/014 05/1/016 06/01/014 05/1/016 08/19/014 05/1/016 JEWISH FAMILY SVS - BAYSHORE, 5800 N BAYSHORE DRIVE, GLENDALE, WI 509 JEWISH FAMILY SVS BROWN DEER ELEMENTARY, 5757 WEST DEAN ROAD, BROWN DEER, WI 5 JEWISH FAMILY SVS CENTRAL CITY CYBERSCHOOL, 401 NORTH 44TH ST, MILWAUKEE, WI 516 JEWISH FAMILY SVS NATIVITY JESUIT MIDDLE SCHOOL, 1515 SOUTH 9TH STREET, MILWAUKEE, WI JEWISH FAMILY SVS-BROWN DEER MIDDLE/HIGH SCHOOL, 8060 NORTH 60TH STREET, MILWAUKEE, JEWISH FAMILY SVS-NORTH POINT LIGHTHOUSE CHARTER, 400 WEST DOUGLAS AVENUE, MILWAU 06/01/014 05/1/016 06/01/014 05/1/016 06/01/014 05/1/016 06/01/014 08/14/015 08/19/014 05/1/016 08/19/014 08/14/015 LA CAUSA, INC. 11 S 70TH ST #115A MILWAUKEE, WI 514 Surveyor: Merrilee Follensbee Lic #: 67 CHYRA TROST Initial Cert: 04//00 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 04/0/017 05/01/015 04/0/017 LIGHTHOUSE CLINIC, LLC 54 E WEBSTER PLACE #0 MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee Lic #: 1509 MARGO RENNER Initial Cert: 01/01/1990 [email protected] Phone: (414) /01/014 01/1/016 Fax: (414) /01/014 01/1/016 1 LIGHTHOUSE CLINIC, 1150 N PORT WASHINGTON RD #107, MEQUON, WI 509 0/01/014 01/1/016 1 LIGHTHOUSE CLINIC, 1180 W NORTH AVENUE, #07, MILWAUKEE, WI 56 0/01/014 01/1/016 LOCKETT ENTERPRISES, LLC BEHAVIORAL HEALTH SERVICES Lic #: 09 0 W WELLS STREET, SUITE 14 MILWAUKEE, WI 50 OTIS LOCKETT JR. Initial Cert: 07/9/014 [email protected] Phone: (414) /01/015 07/1/016 Fax: (414) -07 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/016 08/01/015 07/1/016 08/01/015 07/1/016 11/4/015 Page 95 of 186

96 M & S CLINICAL SERVICES, INC. 81 NORTH 4TH ST #516 MILWAUKEE, WI 51 Lic #: 1546 MARK FOSSIE Initial Cert: 1/04/1996 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) 6-70 CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 04/01/015 0/8/017 MATTERS OF THE SPIRIT, LLC 6815 WEST CAPITOL DRIVE, SUITE 11 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 06 PASTOR TINA SANFORD Initial Cert: 01/01/015 [email protected] Phone: (414) /01/015 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA Lic #: N MAYFAIR ROAD MILWAUKEE, WI 56 JEFFREY G MILLER Initial Cert: 07/01/1996 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 MD THERAPY 6815 W CAPITOL DRIVE, #08 MILWAUKEE, WI 516 Lic #: 5 THOMAS (MIKE) DALE Initial Cert: 05/05/000 [email protected] Phone: (414) /01/015 05/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 05/1/016 01/01/015 05/1/016 11/4/015 Page 96 of 186

97 MEDINA'S WAY 6815 WEST CAPITAL DRIVE #0 MILWAUKEE, WI 516 Lic #: 979 SHARON MEDINA Initial Cert: 09/18/01 Phone: (414) /01/015 08/1/017 Fax: (414) /01/015 08/1/017 1 MEDINAS WAY, WEST NATIONAL AVE, MILWAUKEE, WI /01/015 08/1/017 META HOUSE, INC. 65 N WEIL STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee Lic #: 17 CHRISTINE ULLSTRUP Initial Cert: 11/4/1999 [email protected] Phone: (414) /01/015 11/0/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 11/0/017 1/01/015 11/0/017 1/01/015 11/0/017 MILWAUKEE CENTER FOR INDEPENDANCE DBA WHOLE HEALTH CLINICAL GROUP Lic #: S. 70TH STREET MILWAUKEE, WI 514 TIM MCGUIRE Initial Cert: 09/01/1985 [email protected] Phone: (414) /01/015 05/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 05/1/017 11/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 057 S 14TH STREET, MILWAUKEE, WI /01/015 05/1/017 1 CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI /01/015 05/1/017 1 MILWAUKEE CENTER FOR INDEPENDENCE, 00 W WELLS STREET, MILWAUKEE, WI 5 11/01/015 05/1/017 1 NEXDAY, SOUTH HOWELL AVE, MILWAUKEE, WI /01/015 05/1/017 1 TRANSITIONAL LIVING SERVICES INC, 710 DOUGLAS AVENUE, RACINE, WI /01/015 05/1/017 1 WATER TOWER VIEW, 98 S PRAIRIE HILL LANE, GREENFIELD, WI 58 11/01/015 05/1/017 MILWAUKEE CENTER FOR INDEPENDENCE DBA WHOLE HEALTH CLINICAL GROUP Lic #: S. 70TH STREET MILWAUKEE, WI 514 JOHN CHIANELLI Initial Cert: 09/01/1985 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 06/0/017 11/4/015 Page 97 of 186

98 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION Lic #: WATERTOWN PLANK ROAD MILWAUKEE, WI 56 JENNIFER BERGERSEN Initial Cert: 08/01/1977 Phone: (414) /01/015 10/1/017 Fax: (414) MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION MOBILE URGENT TREATMENT TEAM Lic #: WATERTOWN PLANK ROAD MILWAUKEE, WI 56 STEVEN DYKSTRA Initial Cert: 11/01/1996 Phone: (414) /01/015 10/1/017 Fax: (414) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: WEST WATERTOWN PLANK ROAD MILWAUKEE, WI 56 AMY LORENZ Initial Cert: 09/01/014 Phone: (414) /01/015 08/1/016 Fax: CCS REGIONAL MODEL POPULATION-BASED DHS 6 1 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, W LISBON AVENUE, MILWAUKEE, WI 1 BELL THERAPY, INC, 4065 N 5TH STREET, MILWAUKEE, WI JUSTICE POINT, 05 W HIGHLAND AVE #01, MILWAUKEE, WI 5 1 LA CAUSA, INC SOCIAL SERVICES, 804 W GREENFIELD AVE, MILWAUKEE, WI 56 1 MCFI DBA TLS BEHAVIORAL HEALTH, 1040 S 70TH STREET, MILWAUKEE, WI OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI ST CHARLES YOUTH & FAMILY SERVICES, INC, 4757 N 76TH STREET, MILWAUKEE, WI THE GUEST HOUSE OF MILWAUKEE, 116 N 1TH STREET, MILWAUKEE, WI WISCONSIN COMMUNITY SERVICES, 7 W WISCONSIN AVE. SUITE 00, MILWAUKEE, WI /01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/018 08/1/016 MILWAUKEE HEALTH SERVICES, INC. DBA BEHAVIORAL HEALTH SERVICES CENTER Lic #: W SILVER SPRING DRIVE MILWAUKEE, WI 518 Surveyor: Merrilee Follensbee DR. TITO IZARD. Initial Cert: 05/01/1994 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 MARTIN LUTHER KING-HERITAGE HEALTH CENTER, 555 N MARTIN LUTHER KING JR DRIVE, MILWAU 05/01/015 04/0/017 11/4/015 Page 98 of 186

99 MILWAUKEE MENTAL HEALTH ASSOCIATES COMMUNITY SUPPORT PROGRAM Lic #: W FOND DU LAC AVENUE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee ARTHUR NOBLE Initial Cert: 0/18/1997 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 08/01/015 07/1/017 MILWAUKEE MENTAL HEALTH ASSOCIATES, INC - NATIONAL, 0 W NATIONAL AVE, MILWAUKEE, WI 08/01/015 07/1/017 MINDSTAR COUNSELING, LLC 6114 W CAPITOL DRIVE, SUITE 10 MILWAUKEE, WI 516 Lic #: 891 STARLETTE PATTERSON Initial Cert: 1/01/009 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) /01/014 11/0/016 MULTI-CULTURAL COUNSELING SERVICES II INC, DBA RENEW COUNSELING SERVICES Lic #: W CAPITOL DR SUITE #105 MILWAUKEE, WI 504 WAYNE CROATT Initial Cert: 1/01/01 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 NEW CHOICES, LLC 565 N MARTIN LUTHER KING DR MILWAUKEE, WI 51 Lic #: 90 LEOLA WILLIAMS Initial Cert: 10/14/010 [email protected] Phone: (414) /01/015 09/0/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 Page 99 of 186

100 NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY, INC. Lic #: N FARWELL, SUITE 00 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THERESA ANTHONY Initial Cert: 1/01/014 [email protected] Phone: (414) /01/014 11/0/015 Fax: (866) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/015 1/01/014 11/0/015 1/01/014 11/0/015 OMNI ENRICHMENT, INC. 00 W. VLIET STREET MILWAUKEE, WI 508 Lic #: 41 BARBARA TRIPP Initial Cert: 0/01/00 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 OUTREACH COMMUNITY HEALTH CENTER INC RECOVERY CSP Lic #: W CAPITOL DRIVE MILWAUKEE, WI 506 LIZ GABRIEL Initial Cert: 07/17/1996 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/015 06/0/017 OUTREACH COMMUNITY HEALTH CENTERS INC 10 W CAPITOL DRIVE MILWAUKEE, WI 51 Lic #: 46 ANGELA SANDERS Initial Cert: 08/01/000 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI /01/014 07/1/016 11/4/015 age 100 of 186

101 PARADIGM ENRICHMENT SERVICES, INC WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 990 FREDERICK G. JACKSON, II Initial Cert: 0/5/01 Phone: (414) /01/015 0/8/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 PARK WEST SOCIAL & PSYCHOTHERAPY SERVICES INC Lic #: 7 77 N MARTIN LUTHER KING DRIVE #10 MILWAUKEE, WI 51 CLORINE HARRIS Initial Cert: 04/06/007 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) /01/015 0/1/017 PASTORAL COUNSELING SERVICE OF THE GREATER MILWAUKEE AREA Lic #: N MAYFAIR ROAD SUITE 101 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee STEVEN FRINGER Initial Cert: 08/07/1995 [email protected] Phone: (6) /01/014 07/1/016 Fax: (414) PASTORAL COUNSELING SERV OF GREATER MILW, 745 MAIN STREET, RACINE, WI /01/014 07/1/016 08/01/014 07/1/016 PATHFINDERS MILWAUKEE, INC Lic #: N HOLTON STREET, #400 MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee CATHY ARNEY Initial Cert: 04/01/011 [email protected] Phone: (414) /01/014 05/1/016 Fax: (414) /01/014 05/1/016 PENFIELD CHILDREN'S CENTER 8 N 6TH STREET MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 9 HEATHER ROTOLO Initial Cert: 10/01/010 [email protected] Phone: (414) /01/015 09/0/017 Fax: (414) /01/015 09/0/017 11/4/015 age 101 of 186

102 POSITIVE OUTLOOK CLINICAL SERVICES LLC 445 NORTH 60TH STREET MILWAUKEE, WI 518 Lic #: 796 PAMELA HANSEN Initial Cert: 08/01/008 Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP Lic #: WEST CAPITOL DRIVE STE LL MILWAUKEE, WI 516 CARLA WILLIAMS Initial Cert: 01/16/01 [email protected] Phone: (414) /01/015 0/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/016 04/01/015 0/1/016 04/01/015 0/1/016 PROJECT ACCESS, INC. CSP 8 S 60TH STREET MILWAUKEE, WI 514 Lic #: 1751 C ROGER ZHONG Initial Cert: 1/0/1995 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/015 0/8/017 PSYCARE-MILWAUKEE LLC 6 W. WISCONSIN AVENUE, #1810 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 1445 THOMAS A GARLAND Initial Cert: 06/04/007 [email protected] Phone: (414) 71-06/01/015 05/1/016 Fax: (414) /01/015 05/1/016 RELEVANCE COUNSELING SERVICES 65 W OKLAHOMA AVENUE MILWAUKEE, WI 515 Surveyor: Merrilee Follensbee Lic #: 919 ROSIE MALDONADO Initial Cert: 07/9/010 relevancecounselingservices@juno. Phone: (414) /01/014 06/0/016 Fax: (414) /01/014 06/0/016 11/4/015 age 10 of 186

103 RENEW COUNSELING SERVICES 15 W. MITCHELL STREET, # MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 179 WAYNE CROATT Initial Cert: 04/01/1985 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 RIVERSTONE COUNSELING & CRISIS SERVICES, LLC Lic #: W CAPITOL DRIVE, UNIT 6 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee SARA NEWMAN Initial Cert: 10/0/015 [email protected] Phone: (414) /0/015 09/0/016 Fax: (414) /0/015 09/0/016 SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC Lic #: W FLORIST AVENUE #15 MILWAUKEE, WI 509 Surveyor: Merrilee Follensbee SEBASTIAN SSEMPIJJA Initial Cert: 01/14/004 [email protected] Phone: (414) /01/015 1/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 1 SEBASTIAN FAMILY PSYCHOLOGY, 745 W LAYTON AVE, STE 0, MILWAUKEE, WI 51 01/01/015 1/1/016 AUDUBON TECHNOLOGY & COMMUNICATION CENTER, 00 SOUTH 9TH STREET, MILWAUKEE, WI OLIVER WENDALL HOLMES SCHOOL, 46 NORTH BUFFUM STREET, MILWAUKEE, WI 51 01/01/015 1/1/016 01/01/015 1/1/016 SHECAR SUBSTANCE ABUSE/MENTAL HEALTH OUTPATIENT TREATMENT CENTER, LLC Lic #: N 4TH STREET, #08 MILWAUKEE, WI 51 SHEILA R RAMOS Initial Cert: 06/7/011 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 11/4/015 age 10 of 186

104 SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM Lic #: N. RICHARDS STREET MILWAUKEE, WI 51 ELLA DUNBAR Initial Cert: 04/9/00 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER Lic #: N. 76TH STREET MILWAUKEE, WI 518 GLYNIS UNDERWOOD Initial Cert: 01/01/1991 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 01/1/017 0/01/015 01/1/017 1 ST CHARLES - FAMILY DEVELOP CTR, 151 S 84TH STREET, MILWAUKEE, WI 514 0/01/015 01/1/017 ST. LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC Lic #: W OKLAHOMA AVENUE MILWAUKEE, WI 515 KATE CONNELLY Initial Cert: 08/0/006 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 ST. ROSE YOUTH & FAMILY CENTER 801 N. 88TH STREET MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 1876 JESSICA WALDRON Initial Cert: 07/05/1985 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 1 LAD LAKE, INC. DOUSMAN, W50 - S1401 WATERVILLE ROAD, DOUSMAN, WI /8/015 08/1/016 11/4/015 age 104 of 186

105 THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS Lic #: W WALNUT STREET, SUITE -R MILWAUKEE, WI 51 TODD CAMPBELL Initial Cert: 08/19/010 toddcampbell@thebridgehealthclinic Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC - CAPITOL DRIVE, 5 W. CAPITOL DRIVE, #7, MILWAUKEE, WI 5 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC - CAPITOL DRIVE, 6751 W. GREENFIELD AVE., MILWAUKEE, WI 5 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC, INC. - APPLETON AV, 75 APPLETON AVE, MILWAUKEE, WI 51 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC, INC. - BELOIT RD, 9401 BELOIT RD, SUITE 105, MILWAUKEE, WI 5 08/01/015 07/1/017 THE HUMAN DEVELOPMENT CENTER, INC. 68 WEST FOND DU LAC AVE MILWAUKEE, WI 518 Surveyor: Merrilee Follensbee Lic #: 64 JAY PELDO Initial Cert: 01/5/006 [email protected] Phone: (414) /01/015 01/1/016 Fax: (414) /01/015 01/1/016 THE KELLEY CLINIC 116 N. PROSPECT AVENUE MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 07 JANE KELLEY Initial Cert: 05/01/1999 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 THE POWER OF CHANGE INC BEHAVIORAL SERVICES Lic #: N 4TH STREET SUITE 145 MILWAUKEE, WI 51 RHONDA ARMON-BENT Initial Cert: 07/01/011 [email protected] Phone: (414) /01/015 1/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/016 01/01/015 1/1/016 11/4/015 age 105 of 186

106 UNITED COMMUNITY CENTER 1100 S 6TH STREET, RD FLOOR MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 1657 JUAN A. RUIZ Initial Cert: 05/01/1980 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. FRANCIS HOSPITAL Lic #: S 16TH STREET #00 MILWAUKEE, WI 515 BARBARA JONES Initial Cert: 10/7/004 [email protected] Phone: (414) /01/015 10/1/017 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 1 WHEATON FRANCISAN BEHAVIORAL HEALTH - FRANKLIN, 9969 S 7TH STREET, FRANKLIN, WI 51 11/01/015 10/1/017 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH REGIONAL MEDICAL CTR Lic #: W CHAMBERS ST #P10 MILWAUKEE, WI 510 CAROL HESS Initial Cert: 10/7/004 [email protected] Phone: (414) /01/015 10/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 10/1/017 11/01/015 10/1/017 1 WHEATON FRANCISCAN MEDICAL GROUP, 5650 N. GREEN BAY AVENUE, SUITE 00, GLENDALE, WI 5 11/01/015 1/11/015 WILLOWGLEN ACADEMY OUTPATIENT CLINIC 4065 NORTH 5TH STREET STE # N100 MILWAUKEE, WI 516 Lic #: 004 SHANNA MALONEY Initial Cert: 08/01/199 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 1 WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI /01/014 07/1/016 WILLOWGLEN ACADEMY - DAY ONE EAST, 6414 W. FOND DU LAC AVE, MILWAUKEE, WI 518 WILLOWGLEN ACADEMY, 5555 NORTH 51ST BLVD, MILWAUKEE, WI 518 WILLOWGLEN ACADEMY-HOWARD JANSEN LEARNING, W16 COUNTY HWY FF, SHEBOYGAN, WI 5 WILLOWGLEN ACADEMY - ARROWHEAD UNION HS, 700 NORTH AVE, HARTLAND, WI /01/014 07/1/016 08/01/014 07/1/016 08/01/014 01/01/015 08/01/014 07/1/016 11/4/015 age 106 of 186

107 WISCONSIN COMMUNITY SERVICES OUTPATIENT MENTAL HEALTH PROGRAM Lic #: W WISCONSIN AVENUE MILWAUKEE, WI 508 COLLEEN DUBLINSKI Initial Cert: 06/01/1977 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) /01/015 06/0/017 WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIALS Lic #: W WELLS STREET #500 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THOMAS CARROLL Initial Cert: 06/01/1986 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 UNLIMITED POTENTIAL MILW CNTY DAY REPORT CNTR, 167 SOUTH 9TH STREET, MILWAUKEE, WI 5 10/01/014 10/01/014 WISCONSIN COMMUNITY SERVICES-COMMUNITY SUPPORT PROGRAM Lic #: W WISCONSIN AVENUE MILWAUKEE, WI 508 SUSAN COLLYARD Initial Cert: 11/01/1995 [email protected] Phone: (414) /01/014 10/1/016 Fax: (414) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 BEHRENS PSYCHOTHERAPY SERVICES, LLC 1 E CAPITOL DRIVE, #400 SHOREWOOD, WI 511 Surveyor: Merrilee Follensbee Lic #: 951 JENNA BEHRENS Initial Cert: 1/01/011 [email protected] Phone: (6) /01/014 11/0/016 Fax: (6) BEHRENS PSYCHOTHERAPY SERVICES, LLC, 100 W. SIERRA LN. SUITE D, MEQUON, WI BEHRENS PSYCHOTHERAPY SERVICES, LLC, 140 S MAIN STREET, THIENSVILLE, WI 509 1/01/014 11/0/016 06/01/015 11/0/016 1/01/014 05/1/015 NEW LEAF THERAPIES LLC Lic #: N OAKLAND AVE STE 400 D SHOREWOOD, WI 511 LYNN DELAHAN Initial Cert: 0/01/01 [email protected] Phone: (414) -7 0/01/015 0/8/017 Fax: (414) -8 0/01/015 0/8/017 11/4/015 age 107 of 186

108 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C. Lic #: W LISBON AVENUE, #1 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee KAREN DREXLER Initial Cert: 11/0/1997 [email protected] Phone: (414) /01/015 11/0/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 11/0/017 1/01/015 11/0/017 1 ALTERNATIVES IN PSYCH CONSULT, 5757 WEST OKLAHOMA AVE, MILWAUKEE, WI 519 1/01/015 11/0/017 ANGELS COUNSELING & THERAPY SERVICE WEST NORTH AVE STE #05 WAUWATOSA, WI 56 Lic #: 874 AUGUSTINA GARBA Initial Cert: 08/01/009 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) /01/015 07/1/017 APPLIED THERAPIES AND WELLNESS CENTER SC Lic #: N MAYFAIR ROAD, #05 WAUWATOSA, WI 56 Surveyor: Merrilee Follensbee TRISHA WOLLIN Initial Cert: 05/0/007 twollin@appliedtherapiesandwellnes Phone: (414) /01/014 05/1/016 Fax: (414) 0-14 CSAS-OUTPATIENT TREATMENT DHS /01/014 05/1/015 06/01/014 05/1/016 AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA Lic #: DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 0/1/004 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 11/4/015 age 108 of 186

109 AURORA PSYCHIATRIC HOSPITAL INC 10 DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee Lic #: 1647 JAMIE LEWISTON Initial Cert: 09/01/1979 Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 CHILDYNAMICS, LLC W. NORTH AVENUE, #110 WAUWATOSA, WI 56 Lic #: 199 DR ISABELLA SARDAS Initial Cert: 0/15/000 Phone: (414) /01/015 0/8/017 Fax: (414) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 0/01/015 0/8/017 0/01/015 0/8/017 FAMILY OPTIONS COUNSELING, LLC 015 N 114TH STREET WAUWATOSA, WI 5 Lic #: 69 KIMBERLY YOUNG Initial Cert: 11/0/006 [email protected] Phone: (414) /01/015 10/1/017 Fax: (414) /01/015 10/1/017 11/4/015 age 109 of 186

110 LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN Lic #: N. MAYFAIR ROAD WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee CHUCK MESECK Initial Cert: 0/01/1978 [email protected] Phone: (414) /01/014 0/1/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 1 LCFS-ST JOHN LUTHERAN CHURCH, 4850 S LAKE DRIVE, CUDAHY, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 18 S. PARK AVENUE, NEENAH, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 1614 S. RD STREET, SHEBOYGAN, WI /01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 10 S. ONEIDA STREET, GREEN BAY, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 60 VINCENT ST, FOND DU LAC, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 8 RARITAN, FITCHBURG, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 940 MINERAL POINT RD, JANESVILLE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 00 BROADWAY DRIVE, SUN PRAIRIE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4 S. ANDREWS STREET, SHAWANO, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 45 NORTH PINE ST, REEDSBURG, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 701 WASHINGTON ST, GRAFTON, WI /01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 70 JACKSON AVENUE, OMRO, WI /01/015 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG STREET, PORTAGE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E51 CHURCH ROAD, ALGOMA, WI /01/014 0/1/016 SHORE COUNSELING AND CONSULTING CLINIC 600 N MAYFAIR ROAD, #650 WAUWATOSA, WI 56 Lic #: 501 THOMAS TROAST Initial Cert: 11/4/00 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) /01/014 11/0/016 1 SHORE COUNSELING & CONSULTING CLINIC, 105 N PORT WASHINGTON ROAD, MEQUON, WI 509 1/01/014 11/0/016 1 SHORE COUNSELING & CONSULTING CLINIC, 6110 N PORT WASHINGTON ROAD, GLENDALE, WI 5 1/01/014 11/0/016 1 SHORE COUNSELING & CONSULTING CLINIC, 700 WEST VIRGINIA ST, MILWAUKEE, WI 504 1/01/014 11/0/016 THE REDI CLINIC - A DIVISION OF PATHWAY CLINIC, SC Lic #: N MAYFAIR ROAD, #45 WAUWATOSA, WI 56 DAVID DRAJKOWSKI Initial Cert: 09/09/008 [email protected] Phone: (414) /01/015 09/0/017 Fax: (414) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 110 of 186

111 TOTTY AND ASSOCIATES 751 W NORTH AVENUE WAUWATOSA, WI 51 Lic #: 866 CYNTHIA TOTTY-HEFLEY Initial Cert: 06/01/009 [email protected] Phone: (414) /01/014 05/1/016 Fax: (414) /01/014 05/1/016 WEST GROVE CLINIC 1001 WEST CAPITOL DRIVE #101 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee Lic #: 18 TRACI MARETT Initial Cert: 06//001 [email protected] Phone: (414) /01/014 06/0/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 WEST GROVE CLINIC LLC, 1111 W NORTH AVENUE, #0, WAUWATOSA, WI 56 07/01/014 1/19/014 WEST GROVE CLINIC LLC, 710 W. WELLS ST., WAUWATOSA, WI 51 04/0/015 06/0/016 WEST GROVE CLINIC, 5 N. BROOKFIELD RD. #4, BROOKFIELD, WI /19/014 04/19/015 AURORA BEHAVIORAL HEALTH CENTER - WEST ALLIS Lic #: S 90TH STREET SUITE 50 WEST ALLIS, WI 57 KATE CONNELLY Initial Cert: 07/1/00 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 MAPLEGROVE TREATMENT CENTER 1455 S 97TH STREET WEST ALLIS, WI 514 Lic #: 06 TIM KABARA Initial Cert: 04/08/014 timkabara@maplegrovetreatmentce Phone: (6) /01/015 0/1/016 Fax: 04/01/015 0/1/016 NEW BEGINNINGS MENTAL HEALTH CLINIC, LLC Lic #: W BELOIT RD WEST ALLIS, WI 519 RUTH KOHNKE Initial Cert: 08/05/014 [email protected] Phone: (414) /05/014 07/1/015 Fax: (414) /05/014 07/1/015 11/4/015 Page 111 of 186

112 ROGERS MEMORIAL HOSPITAL 448 SOUTH 10ND ST RM #00 WEST ALLIS, WI 57 Lic #: 0 KEITH MOREHOUSE Initial Cert: 05/01/014 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREAT/CHILDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /01/014 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 ROGERS MEMORIAL HOSPITAL - MILWAUKEE W. LINCOLN AVENUE WEST ALLIS, WI 57 Surveyor: Merrilee Follensbee Lic #: 14 CATHERINE HENRICKS Initial Cert: 05/01/000 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 STRESS MANAGEMENT AND MENTAL HEALTH CLINICS Lic #: W LINCOLN AVENUE, #08 WEST ALLIS, WI 57 CRAIG MODELL Initial Cert: 06/01/1980 [email protected] Phone: (414) /01/015 05/1/017 Fax: (414) /01/015 05/1/017 1 STRESS MANAGEMENT & MENTAL HEALTH CLINICS, N116 W16150 MAIN STREET, GERMANTOWN, WI 06/01/015 05/1/017 11/4/015 age 11 of 186

113 Monroe County SCENIC BLUFFS COMMUNITY HEALTH CENTERS Lic #: FRONT STREET CASHTON, WI Monroe County Surveyor: Roderic Senn JESSICA MLSNA Initial Cert: 07/8/008 Phone: (608) /01/014 06/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 MONROE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: HWY B, COMM SVS CTR A-19 SPARTA, WI Monroe County Surveyor: Roderic Senn TRACY THORSEN Initial Cert: 10/01/1975 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 11/4/015 age 11 of 186

114 Oconto County NORTHERN HEALTH CENTERS INC. NICOLET MEDICAL & DENTAL CLINIC Lic #: HIGHWAY LAKEWOOD, WI 5418 Oconto County JODI MARSH Initial Cert: 07/4/009 Phone: (715) /01/014 07/1/016 Fax: (715) /01/014 07/1/016 1 NORTHERN HEALTH CENTERS, INC - WHITE LAKE CLINIC, 54 BISSEL STREET, WHITE LAKE, WI /0/014 07/1/016 WABENO ELEMENTARY SCHOOL, 446 MILL LANE, WABENO, WI /0/014 07/1/016 BELLIN PSYCHIATRIC CENTER OCONTO HOSPITAL & MEDICAL CENTER Lic #: ARBUTUS AVENUE OCONTO, WI 5415 Oconto County STEVE DUSCHER Initial Cert: 10//007 sldusc@bellin. org Phone: (90) /01/014 10/1/016 Fax: (90) 41-0 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 11/01/014 10/1/016 11/01/014 10/1/016 1 BELLIN PSYCHIATRIC CENTER-MARINETTE, 1 SHORE DRIVE, MARINETTE, WI /01/014 10/1/016 OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: PARK AVENUE OCONTO, WI 5415 Oconto County BRUCE RETZLAFF Initial Cert: 04/01/1979 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 1 NEW VIEW INDUSTRIES, 164 W PARK STREET, GILLETT, WI /01/014 08/1/016 11/4/015 age 114 of 186

115 Oneida County MARSHFIELD CLINIC MINOCQUA COUNSELING CENTER Lic #: TOWNLINE ROAD MINOCQUA, WI Oneida County Surveyor: Polly Wong KAREN SWARTZ Initial Cert: 11/01/1999 Phone: (715) /1/015 10/1/016 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 04/1/015 10/1/016 04/1/015 10/1/016 MARSHFIELD CLINIC COUNSELING CENTER, 50 SHERRY AVENUE, PARK FALLS, WI /1/015 10/1/016 NORTH CENTRAL COUNSELING SERVICES JOSEPH ROE & ASSOC /DBA SHIRLEY LIMBERG Lic #: HIGHWAY 51 NORTH MINOCQUA, WI Oneida County Surveyor: Polly Wong SHIRLEY LIMBERG Initial Cert: 0/01/000 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 1 NCCS J ROE & ASSOC DBA SHIRLEY LIMBERG, HIGHWAY 1 - SOUTH, PARK FALLS, WI /01/014 0/1/016 CORNERSTONE PSYCHOLOGICAL ASSOCIATES, LLC Lic #: S ONEIDA AVE SUITE 101 RHINELANDER, WI Oneida County Surveyor: Polly Wong THOMAS F. MCGUIRE, LPC Initial Cert: 08/14/01 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 115 of 186

116 OPTIONS COUNSELING SERVICES, LLC 158 SOUTH ANDERSON STREET, SUITE 1 RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 74 BRUCE DECORAH Initial Cert: 04/17/007 [email protected] Phone: (715) //015 0/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS //015 0/1/016 11//015 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 7 EAST WALL STREET, EAGLE RIVER, WI //015 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 944 COUNTY RD J, PO BOX 7, MINOCQUA, WI //015 0/1/016 OPTIONS COUNSELING SERVICES LLC, 1991 WINNEBAGO STREET, RHINELANDER, WI ANTIGO HIGH SCHOOL, 1900 TENTH AVENUE, ANTIGO, WI ANTIGO MIDDLE SCHOOL, 815 SEVENTH AVENUE, ANTIGO, WI ARBOR VITAE-WOODRUFF ELEMENTARY SCHOOL, OLD STATE HWY 51 NORTH, ARBOR VITAE, CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI CRANDON ELEMENTARY/ MIDDLE/HIGH SCHOOL, 9750 US HWY 8 WEST, CRANDON, WI 5450 CRESCENT ELEMENTARY, 19 BOYCE DRIVE, RHINELANDER, WI CRESTWOOD ELEMENTARY SCHOOL, W8464 CH AA, ANTIGO, WI EAGLE RIVER ELEMENTARY SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 EAST ELEMENTARY SCHOOL, 0 SEVENTH AVENUE, ANTIGO, WI JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI LAKELAND UNION HIGH SCHOOL DISTRICT, 957 STATE HIGHWAY 70, MINOCQUA, WI LAND O' LAKES ELEMENTARY, 6485 TOWN HALL ROAD, LAND O LAKES, WI MATTOON ELEMENTARY SCHOOL, 507 STONE AVENUE, MATTOON, WI NORTH ELEMENTARY SCHOOL, 506 GRAHAM AVENUE, ANTIGO, WI NORTHLAND PINES HIGH SCHOOL, 1800 PLEASURE ISLAND ROAD, EAGLE RIVER, WI 5451 NORTHLAND PINES MIDDLE SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 NORTHWOODS COMM. SECONDARY CHARTER SCHOOL, 665 COOLIDGE AVENUE, RHINELANDER, W NORTHWOODS COMMUNITY ELEMENTARY CHARTER SCHOOL, 9086 COUNTY HWY K, HARSHAW, WI PELICAN ELEMENTARY, 50 V HICKEY ROAD, RHINELANDER, WI PLEASANT VIEW ELEMENTARY SCHOOL, W11141 CTY RD HH, ANTIGO, WI RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI SOAR CHARTER SCHOOL, 6485 TOWN HALL RD, LAND O LAKES, WI SPRING VALLEY ELEMENTARY, N4754 CTH BB, ANTIGO, WI ST GERMAIN ELEMENTARY SCHOOL, 84 HWY 70 WEST, SAINT GERMAIN, WI SUGAR CAMP ELEMENTARY, 4066 CAMP FOUR RD., RHINELANDER, WI THREE LAKES ELM/JUNIOR & SENIOR HIGH SCHOOL, 690 WEST SCHOOL ST, THREE LAKES, WI 545 WEST ELEMENTARY, 1 SEVENTH AVENUE, ANTIGO, WI //015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 11//015 0/1/016 PRICE-DECKER CLINIC, LLC 48 W KING STREET RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 51 TERRY PRICE-DECKER Initial Cert: 07/01/004 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) /01/014 08/1/016 11/4/015 age 116 of 186

117 ST. MARY'S HOSPITAL MINISTRY BEHAVIORAL HEALTH INPATIENT Lic #: N. SHORE DRIVE, #100 RHINELANDER, WI Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 05/01/004 Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 ST. MARY'S HOSPITAL MINISTRY KOLLER BEHAVIORAL HEALTH Lic #: KABEL AVENUE RHINELANDER, WI Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 06/01/1985 Phone: (715) /01/014 05/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 05/1/016 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI /01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 90 E WALL STREET, EAGLE RIVER, WI /01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI /01/014 05/1/016 ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 11 ELM STREET, WOODRUFF, WI /01/014 05/1/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 147 DONNA SHIMECK Initial Cert: 09/01/1980 [email protected] Phone: (715) /01/015 09/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 04 DONNA SHIMECK Initial Cert: 06/7/014 Phone: (715) /01/015 06/0/017 Fax: (715) CCS REGIONAL MODEL UNIFIED BOARD DHS 6 CCS REGIONAL MODEL UNIFIED BOARD W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 117 of 186

118 THE HUMAN SERVICE CENTER CSP 705 E. TIMBER DRIVE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 146 DONNA SHIMECK Initial Cert: 09/01/1980 Phone: (715) /01/014 05/1/016 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 06/01/014 05/1/016 06/01/014 05/1/016 TRANSITIONS CENTER, LLC N PELHAM STREET RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 64 RICHARD MARTIN Initial Cert: 0/01/006 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 01/1/017 0/01/015 01/1/017 11/4/015 age 118 of 186

119 Outagamie County AFFINITY MEDICAL GROUP BEHAVIORAL HEALTH Lic #: S MADISON ST #580 APPLETON, WI Outagamie County NADINE DUNCAN Initial Cert: 01/0/005 [email protected] Phone: (90) /01/015 10/1/017 Fax: (90) /01/015 10/1/017 1 AFFINITY MEDICAL GROUP PEDIATRICS-OAKWOOD CLINIC, 700W NINTH AVENUE, OSHKOSH, WI 54 11/01/015 10/1/017 1 AFFINITY MEDICAL GROUP-BEHAVIORAL HEALTH, 601 FIELDCREST, KAUKAUNA, WI /01/015 10/1/017 AFFINITY MEDICAL GROUP, 1501 SOUTH MADISON ST, APPLETON, WI AFFINITY MEDICAL GROUP, 9 N, RICHMOND ST, APPLETON, WI AFFINITY MEDICAL GROUP-BEHAVIORAL HEALTH, 1855 S KOELLER, OSHKOSH, WI 5490 AFFINITY MEDICAL GROUP-BEHAVIORAL HEALTH, 00 PATRIOT DRIVE, LITTLE CHUTE, WI /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 CATALPA HEALTH DAY TREATMENT 190 N CASALOMA ST APPLETON, WI 5491 Outagamie County Lic #: 097 GREG BLUME Initial Cert: 07/1/015 [email protected] Phone: (90) /1/015 06/0/016 Fax: (90) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 07/1/015 06/0/016 11/4/015 age 119 of 186

120 CATALPA HEALTH, INC. 444 NORTH WESTHILL BLVD APPLETON, WI Outagamie County Lic #: 984 GREG BLUME Initial Cert: 11/01/01 Phone: (90) /01/015 10/1/017 Fax: (90) CSAS-PREVENTION DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 1 BOYS AND GIRLS CLUB OF OSHKOSH, 501 E PARKWAY AVE., OSHKOSH, WI /01/016 10/1/017 1 CATALPA HEALTH - CASALOMA CAMPUS, 190 N CASALOMA ST, APPLETON, WI /01/015 10/1/017 CATALPA HEALTH ACCESS CENTER, 44 WESTHILL BLVD., APPLETON, WI CATALPA HEALTH, 181 WITZEL AVE, OSHKOSH, WI 5490 BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 08 EAST BURDICK ST, BLACK CREEK, WI FREEDOM ELEMENTARY SCHOOL, N569 COUNTY ROAD E, FREEDOM, WI 5411 FREEDOM HIGH & MIDDLE SCHOOLS, N401 COUNTY ROAD E, FREEDOM, WI 5411 GREENVILLE ELEMENTARY SCHOOL, W68 GREENRIDGE DR., GREENVILLE, WI 5494 GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR., GREENVILLE, WI 5494 HORIZON ELEMENTARY SCHOOL, 101 SCHAEFER CIRCLE, APPLETON, WI HORTONVILLE ELEMENTARY SCHOOL, 40 WARNER ST., HORTONVILLE, WI HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 0, HORTONVILLE, WI HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST; PO BOX 59, HORTONVILLE, WI MADISON MIDDLE SCHOOL, 00 S. CARPENTER STREET, APPLETON, WI MENASHA HIGH SCHOOL, 40 SEVENTH STREET, MENASHA, WI 5495 NORTH GREENVILLE ELEMENTARY SCHOOL, N468 LEARNING WAY, GREENVILLE, WI 5494 OSHKOSH NORTH HIGH SCHOOL, 1100 W. SMITH AVE., OSHKOSH, WI ROCKLEDGE PRIMARY/INTERMEDIATE CENTERS, 0 WEST HICKORY ST, SEYMOUR, WI ROOSEVELT MIDDLE SCHOOL, 18 EAST BREWSTER ST, APPLETON, WI SEYMOUR MIDDLE & HIGH SCHOOLS, 10 CIRCLE DRIVE, SEYMOUR, WI SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI WASHINGTON ELEMENTARY SCHOOL, 99 WINNEBAGO AVE, OSHKOSH, WI WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 CATHOLIC CHARITIES DIOCESE OF GREEN BAY, INC. Lic #: E. SUMMER STREET APPLETON, WI Outagamie County CELIA J. LATOUR Initial Cert: 01/6/1988 [email protected] Phone: (90) /01/014 01/1/016 Fax: (90) /01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 6 BROAD ST, #00, OSHKOSH, WI /01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 64 S CAMBRIDGE STREET, WAUTOMA, WI /01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, N845 SHADOW RD, WAUPACA, WI /01/014 01/1/016 11/4/015 age 10 of 186

121 LUTHERAN SOCIAL SERVICES 00 B NORTH RICHMOND ST APPLETON, WI Outagamie County Lic #: 87 REBECKA HELDT Initial Cert: 06/0/009 [email protected] Phone: (90) /01/015 08/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 1 LSS- OSHKOSH OLDER ADULT PROGRAMS, 00 N CAMPBELL, OSHKOSH, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 115 NORTH 6TH STREET, WAUSAU, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1500 DOUGLAS DRIVE, PLYMOUTH, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1777 WEST MAIN STREET STE 1, SUN PRAIRIE, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 445 PARK AVENUE, BELOIT, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 706 N 9TH STREET, SHEBOYGAN, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 74 SOUTH MAIN ST #10, FOND DU LAC, WI /01/015 08/1/016 LUTHERAN SOCIAL SERVICES, 81 N GRANDVIEW BLVD #09, PEWAUKEE, WI 507 LUTHERAN SOCIAL SERVICES, NORTH 5TH STREET EAST, SUPERIOR, WI LUTHERAN SOCIAL SERVICES, 61 N RANDALL STREET, JANESVILLE, WI 5545 LUTHERAN SOCIAL SERVICES, 614 ODANA ROAD, MADISON, WI 5719 LUTHERAN SOCIAL SERVICES, 809 N PARK AVENUE, BEAVER DAM, WI 5916 LUTHERAN SOCIAL SERVICES, 80 W COLLEGE AVENUE, APPLETON, WI APPLETON EAST HIGH SCHOOL, 11 NORTH EMMERS DRIVE, APPLETON, WI APPLETON WEST HIGH SCHOOL, 610 NORTH BADGER AVE, APPLETON, WI CLOVIS GROVE ELEMENTARY SCHOOL, 974-9TH STREET, MENASHA, WI 5495 LINCOLN ELEMENTARY SCHOOL, 1000 NORTH MASON ST, APPLETON, WI LSS - NORTHERN LIGHTS ELEMENTARY SCHOOL, 101 NORTH 8TH ST, SUPERIOR, WI LSS - SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI LSS - SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI MENASHA HIGH SCHOOL, 40-7TH STREET, MENASHA, WI 5495 RANDON LAKE HIGH SCHOOL, 605 RANDOM LAKE ROAD, RANDOM LAKE, WI 5075 WILSON MIDDLE SCHOOL, 5 N BADGER AVE, APPLETON, WI /01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/04/015 08/1/016 09/01/015 08/1/016 OUTAGAMIE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP Lic #: S. ELM STREET APPLETON, WI Outagamie County ROSEMARY DAVIS Initial Cert: 07/01/1987 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 11/4/015 age 11 of 186

122 OUTAGAMIE COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: S ELM STREET APPLETON, WI Outagamie County BRIAN BEZIER, PSYD Initial Cert: 07/01/1987 [email protected] Phone: (90) /01/015 11/0/017 Fax: (90) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/015 11/0/017 1/01/015 11/0/017 OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVCIES Lic #: S ELM STREET APPLETON, WI Outagamie County JUDY VAN RYZIN Initial Cert: 04/01/005 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 ROGERS MEMORIAL HOSPITAL - APPLETON 451 W COLLEGE AVE APPLETON, WI Outagamie County Lic #: 098 DAVID DREWEK Initial Cert: 09/1/015 [email protected] Phone: (6) /1/015 08/1/016 Fax: (6) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /1/015 08/1/016 09/1/015 08/1/016 09/1/015 08/1/016 09/1/015 08/1/016 SHERMAN CONSULTING, LLC W6144 AREOTECH DRIVE APPLETON, WI Outagamie County Lic #: 450 HANK SHERMAN, PH.D. Initial Cert: 06/05/00 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) /01/014 05/1/016 1 SHERMAN CONSULTING, LLC, 157 PARK PLACE SUITE 600, GREEN BAY, WI /01/014 05/1/016 11/4/015 age 1 of 186

123 ST. ELIZABETH HOSPITAL 1506 S. ONEIDA STREET APPLETON, WI Outagamie County Lic #: 1860 STEVIE REICH Initial Cert: 0/01/1984 Phone: (90) /01/015 10/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 WELLNESS COUNSELING CENTER 10 W. COLLEGE AVENUE, #815 APPLETON, WI Outagamie County Lic #: 198 BEDFORD HINES Initial Cert: 1/01/1981 Phone: (90) /01/015 10/1/017 Fax: (90) /01/015 10/1/017 WI LUTHERAN CHILD & FAMILY SERVICE, INC. D/B/A CHRISTIAN FAMILY COUNSELING Lic #: N LYNNDALE DRIVE, #1B APPLETON, WI Outagamie County DR MYLES TONNACLIFF Initial Cert: 05/01/1990 [email protected] Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 1 WINNEBAGO LUTHERAN ACADEMY, 475 E MERRILL AVE, FOND DU LAC, WI /7/015 08/1/016 1 WLCFS INC - CHRISTIAN FAMILY COUNSELING, 757 S MAIN STREET, FOND DU LAC, WI /01/014 08/1/016 MEDICAL AND COUNSELING ASSOCIATES N567 MAYFLOWER RD SHIOCTON, WI Outagamie County Lic #: 1578 JOAN HUTCHISON Initial Cert: 01/01/1986 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 MEDICAL & COUNSELING ASSOCIATES KAUKAUNA, 416 CROOKS AVENUE, KAUKAUNA, WI /01/015 01/1/017 MEDICAL AND COUNSELING ASSOCIATES, 00 N WOODS EDGE DR, APPLETON, WI /01/015 01/1/017 11/4/015 age 1 of 186

124 Ozaukee County NORTHSHORE CLINIC & CONSULTANTS, INC. W6 N48 WASHINGTON AVE., #07 CEDARBURG, WI 501 Ozaukee County Lic #: 1695 JOY MYERS Initial Cert: 10/01/1987 Phone: (6) /01/015 07/1/017 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 1 NORTHSHORE CLINIC & CONSULTANTS, 07 E BUFFALO STREET, #510, MILWAUKEE, WI 50 08/01/015 07/1/017 NORTHSHORE CLINIC & CONSULTANTS, 6 S 10ND STREET, #0, WEST ALLIS, WI 57 NORTHSHORE CLINIC & CONSULTANTS, INC., 1615 BARTON AVENUE, WEST BEND, WI /01/015 07/1/017 08/01/015 07/1/017 ALARUS HEALTHCARE, LLC 1971 WASHINGTON ST SUITE 00 GRAFTON, WI 504 Ozaukee County Lic #: 009 MICHAEL J. OWEN Initial Cert: 10/08/01 [email protected] Phone: (6) /01/014 09/0/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 ALARUS HEALTHCARE - WEST BEND, 16 CHESTNUT ST., WEST BEND, WI /06/015 09/0/016 ACHIEVEMENT ASSOCIATES, LTD. 117 W. TOWNE SQUARE ROAD MEQUON, WI 509 Ozaukee County Lic #: 1009 NEENA FLORSHEIM Initial Cert: 05/01/1998 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/015 05/1/017 06/01/015 05/1/017 11/4/015 age 14 of 186

125 AMERICAN BEHAVIORAL CLINICS 140 W RANCHITO LANE MEQUON, WI 509 Ozaukee County Lic #: 68 JAY SCHRINSKY Initial Cert: 05/01/00 [email protected] Phone: (6) /01/014 05/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 05/1/016 07/01/014 05/1/016 1 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #, 970 W BLUEMOUND ROAD, MILWAUKEE, WI 5 07/01/014 05/1/016 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #1, 1044 W BLUEMOUND ROAD, MILWAUKEE, WI 5 AMERICAN BEHAVIORAL CLINICS-ELM GROVE, 1585 WATERTOWN PLANK ROAD, ELM GROVE, WI 5 AMERICAN BEHAVIORAL CLINICS-LAYTON, 70 W LAYTON AVENUE, MILWAUKEE, WI 50 07/01/014 05/1/016 07/01/014 05/1/016 07/01/014 05/1/016 COLUMBIA ST MARY'S BEHAVIORAL MEDICINE-MEQUON Lic #: N PORT WASHINGTON ROAD MEQUON, WI 5097 Ozaukee County WILLIAM FRY Initial Cert: 09/0/00 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 COLUMBIA ST. MARY'S OZAUKEE HOSPITAL BEHAVIORAL HEALTH UNIT Lic #: N PORT WASHINGTON RD MEQUON, WI 5097 Ozaukee County BILL FRY Initial Cert: 09/01/1984 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 0/9/016 0/01/014 0/9/016 NORTH SHORE CENTER, L.L.C. 100 N. PORT. WASHINGTON RD., #0 MEQUON, WI 509 Ozaukee County Lic #: 168 MICHAEL MAZIUS Initial Cert: 1//01 [email protected] Phone: (6) /01/015 0/8/017 Fax: (6) /01/015 0/8/017 11/4/015 age 15 of 186

126 DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY Lic #: W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 Phone: (6) /01/014 09/0/016 Fax: (6) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 1 OZAUKEE COUNTY JAIL, 101 S. SPRING STREET, PORT WASHINGTON, WI /10/016 09/0/016 DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY CSP Lic #: W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 [email protected] Phone: (6) /01/015 0/1/017 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 OZAUKEE COUNTY CCS PROGRAM 11 W MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County Lic #: 050 LIZA DRAKE Initial Cert: 09//014 [email protected] Phone: (6) /01/015 09/0/016 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 10/01/015 09/0/016 11/4/015 age 16 of 186

127 Pierce County PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: W KINNE STREET ELLSWORTH, WI Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 1/01/1981 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES/NORTHWEST CONNECTION Lic #: W. KINNE STREET ELLSWORTH, WI Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 11/01/011 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 04/01/015 0/1/017 PIERCE COUNTY DEPT OF HUMAN SVS 41 WEST KINNE STREET ELLSWORTH, WI Pierce County Surveyor: Roderic Senn Lic #: 00 RON KIESLER Initial Cert: 04/01/014 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 11/4/015 age 17 of 186

128 Polk County AMERY REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH CENTER Lic #: 89 0 DERONDA STREET AMERY, WI Polk County Surveyor: Polly Wong HEATHER ERICKSON Initial Cert: 1/08/008 Heather.E.Erickson@Amerymedical Phone: (715) /01/015 11/0/017 Fax: (715) MENTAL HEALTH-INPATIENT DHS /01/015 11/0/017 1/01/015 11/0/017 1 LUCK CLINIC, AMERY HOSPITAL AND CLINIC, 17 FIRST AVENUE, LUCK, WI /01/015 11/0/017 NORTHWEST JOURNEY - AMERY 1096 APPLE AVENUE AMERY, WI Polk County Surveyor: Polly Wong Lic #: 195 AMY WALLIN Initial Cert: 0/14/000 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/014 01/1/016 0/01/014 01/1/016 POLK COUNTY HUMAN SERVICES DEPARTMENT CSP Lic #: 100 POLK CO PLAZA # TH ST BALSAM LAKE, WI Polk County Surveyor: Polly Wong KRISTIN BOLAND Initial Cert: 01/6/000 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/014 04/0/016 POLK COUNTY MENTAL AND BEHAVIORAL HEALTH SERVICES Lic #: POLK COUNTY PLAZA #50 BALSAM LAKE, WI Polk County Surveyor: Polly Wong KRISTIN BOLAND Initial Cert: 0/08/000 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 11/4/015 age 18 of 186

129 NORTHWEST COUNSELING AND GUIDANCE CLINIC Lic #: 54 0 UNITED WAY DRIVE FREDERIC, WI 5487 Polk County Surveyor: Polly Wong ELLEN RACE Initial Cert: 08/5/1999 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 01/1/016 0/01/014 01/1/016 1 NORTHWEST PASSAGE II, 1661 HAMMS ROAD, SPOONER, WI /01/014 01/1/016 NORTHWEST PASSAGE 1, 7818 MOLINE RD, PO BOX 49, WEBSTER, WI /01/014 01/1/016 PEACE TREE COUNSELING LLC 04 THIRD AVE #100 OSCEOLA, WI 5400 Polk County Surveyor: Polly Wong Lic #: 79 VALERIE ZELLMER Initial Cert: 06/4/008 [email protected] Phone: (715) /01/015 05/1/017 Fax: (715) /01/015 05/1/017 11/4/015 age 19 of 186

130 Portage County OSWALD COUNSELING ASSOCIATES 450 VINEYARD DRIVE PLOVER, WI Portage County Lic #: 566 LYNNE OSWALD Initial Cert: 01/14/005 Phone: (715) /01/014 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 ACS CLINICAL SERVICES, LLC - STEVENS POINT Lic #: STRONGS AVE STE STEVENS POINT, WI Portage County MARK ROSSANO Initial Cert: 09/15/009 [email protected] Phone: (715) /01/015 09/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 09/0/016 08/01/015 09/0/016 1 ACS CLINICAL SERVICES LLC - SPARTA, 101 SOUTH WATER STREET, SPARTA, WI /01/015 09/0/016 1 ACS CLINICAL SERVICES, LLC - WAUSAU, 90 ND STREET, WAUSAU, WI /01/015 09/0/016 ADVOCATE PSYCHOTHERAPY SERVICES, LLC 900 HOOVER AVE, SUITE B STEVENS POINT, WI Portage County Lic #: 051 STEVEN JOHNSON Initial Cert: 10/01/014 office@advocatepsychotherapyserv Phone: (800) /01/015 09/0/016 Fax: (715) ADVOCATE PSYCHOTHERAPY SERVICES, LLC, 146 N. CENTRAL AVE., STE. 04, MARSHFIELD, WI /01/015 09/0/016 10/01/015 09/0/016 KENNEDY ELEMENTARY SCHOOL, 616 WEST SECOND STREET, JUNCTION CITY, WI 5444 MEAD ELEMENTARY CHARTER SCHOOL, 41-17TH STREET SOUTH, WISCONSIN RAPIDS, WI /01/015 09/0/016 10/01/015 09/0/016 MINISTRY BEHAVIORAL HEALTH 09 PRENTICE STREET NORTH STEVENS POINT, WI Portage County Lic #: 117 LAURIE ROBERTS Initial Cert: 05/01/1991 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 10 of 186

131 MINISTRY MEDICAL GROUP-PSYCHIATRY DEPARTMENT Lic #: E MARIA DRIVE STEVENS POINT, WI Portage County LINDA MASSOPUST Initial Cert: 1/01/198 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) /01/014 1/1/015 MINISTRY MEDICAL GROUP PSYCHIATRY DEPT., 1 WILSHIRE BLVD NORTH BLDG, STEVENS POIN 01/1/014 1/1/015 BANNACH ELEMENTARY SCHOOL, 5400 WALTER STREET, STEVENS POINT, WI WASHINGTON ELEMENTARY, 500 PRAIS STREET, STEVENS POINT, WI /15/015 1/1/015 09/15/015 1/1/015 NEW DIRECTIONS COUNSELING CENTER, LLC 5541 HWY 10 EAST, SUITE B STEVENS POINT, WI 5448 Portage County Lic #: 166 DIANE DICKINSON Initial Cert: 09/16/1996 [email protected] Phone: (715) /01/014 05/1/016 Fax: (715) /01/014 05/1/016 1 NEW DIRECTIONS COUNSELING CENTER, TH AVENUE, WOODRUFF, WI /01/014 05/1/016 1 NEW DIRECTIONS COUNSELING CENTER, N919 COUNTY RD QQ, WAUPACA, WI /01/014 05/1/016 BENJAMIN FRANLKLIN JUNIOR HIGH SCHOOL, 000 POLK ST., STEVENS POINT, WI PJ JACOBS JUNIOR HIGH SCHOOL, 400 MAIN ST, STEVENS POINT, WI PLOVER-WHITING ELEMENTARY SCHOOL, 1400 HOOVER AVENUE, PLOVER, WI ROOSEVELT IDEA ELEMENTARY SCHOOL, 00 WISCONSIN AVE., PLOVER, WI STEVENS POINT AREA SENIOR HIGH SCHOOL, 101 NORTH POINT DR., STEVENS POINT, WI /06/015 05/1/016 0/06/015 05/1/016 05/07/015 05/1/016 05/07/015 05/1/016 0/06/015 05/1/016 NORTHWEST JOURNEY - STEVENS POINT 55-4TH AVENUE STEVENS POINT, WI Portage County Lic #: 405 LAURA KOWALSKI Initial Cert: 10/14/00 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/015 01/1/017 0/01/015 01/1/017 PORTAGE COUNTY HEALTH & HUMAN SERVICES Lic #: WHITING AVENUE STEVENS POINT, WI Portage County AMY MARCOTT Initial Cert: 06/01/1976 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 04/01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 11/4/015 age 11 of 186

132 PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: WHITING AVENUE STEVENS POINT, WI Portage County AMY MARCOTT Initial Cert: 0/01/007 Phone: (715) /01/015 0/8/017 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 RIVERWOOD COUNSELING ASSOCIATES LLC 105 MAIN STREET, #0 STEVENS POINT, WI Portage County Lic #: 0 ROBERT A MILLER Initial Cert: 07/17/000 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 SAINT MICHAEL'S HOSPITAL 900 ILLINOIS AVENUE STEVENS POINT, WI Portage County Lic #: 180 LAURIE ROBERTS Initial Cert: 05/01/1978 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 1 of 186

133 Price County COMMUNITY SUPPORT CENTER OF PRICE COUNTY Lic #: N. LAKE AVENUE PHILLIPS, WI Price County Surveyor: Polly Wong PAM OLSON Initial Cert: 04/01/1998 Phone: (715) /01/014 1/1/015 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/014 1/1/015 COUNSELING AND DEVELOPMENT CENTER, INC. Lic #: CHESTNUT STREET PHILLIPS, WI Price County Surveyor: Polly Wong KELLY J. SCHULTZ Initial Cert: 08/01/198 [email protected] Phone: (715) /01/015 07/1/017 Fax: (715) 9-46 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 COUNSELING & DEVELOPMENT CENTER, 14-4TH AVENUE N, PARK FALLS, WI /01/015 07/1/017 COUNSELING AND DEVELOPMENT CENTER, INC. COMMUNITY SUPPORT PROGRAM Lic #: CHESTNUT STREET PHILLIPS, WI Price County Surveyor: Polly Wong MR. KELLY SCHULTZ Initial Cert: 08/01/1998 [email protected] Phone: (715) /01/015 10/1/017 Fax: (715) 9-46 MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 11/01/015 10/1/017 PRICE COUNTY HUMAN SERVICES/COUNSELING AND DEVELOPMENT CENTER Lic #: S EYDER PHILLIPS, WI Price County Surveyor: Polly Wong MARILYN SCHREUDER Initial Cert: 0/01/006 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 01/1/017 11/4/015 age 1 of 186

134 SAFE HAVEN COUNSELING 548 N LAKE AVENUE PHILLIPS, WI Price County Surveyor: Polly Wong Lic #: 79 PAMELA OLSON Initial Cert: 05/01/008 [email protected] Phone: (715) /01/015 04/0/016 Fax: (715) /01/015 04/0/016 11/4/015 age 14 of 186

135 Racine County AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES Lic #: GARDNER AVENUE, # BURLINGTON, WI 5105 Racine County Surveyor: William Rohner KATE CONNELLY Initial Cert: 10/01/198 [email protected] Phone: (6) /01/015 01/1/017 Fax: (6) /01/015 01/1/017 1 AURORA MED GROUP BEHAV HLTH-WATERFORD, 818 FORREST, WATERFORD, WI /01/015 01/1/017 CLINICAL PSYCHOLOGY ASSOCIATES OF BURLINGTON Lic #: MILWAUKEE AVENUE BURLINGTON, WI 5105 Racine County Surveyor: William Rohner DAVID W THOMPSON PHD Initial Cert: 0/01/199 [email protected] Phone: (6) /01/014 0/1/016 Fax: (6) /01/014 0/1/016 1 CLINICAL PSYCHOLOGY ASSOC OF WATERFORD, 07B MILWAUKEE AVENUE, WATERFORD, WI /01/014 0/1/016 PROFESSIONAL PSYCHOLOGICAL SERVICES, S.C. Lic #: MILWAUKEE STREET, # BURLINGTON, WI 5105 Racine County Surveyor: William Rohner DEAN STOLLDORF, PHD Initial Cert: 0/01/1991 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) /01/014 0/9/016 BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY Lic #: TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 08/0/01 [email protected] Phone: (6) /01/015 07/1/017 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 11/4/015 age 15 of 186

136 CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE Lic #: WISCONSIN AVE RACINE, WI 540 Racine County Surveyor: William Rohner MANDY BIBO Initial Cert: 06/01/1981 Phone: (414) /01/014 06/0/016 Fax: (6) /01/014 06/0/016 1 CATHOLIC CHARITIES OF MILW - KENOSHA, 4 45TH ST., KENOSHA, WI /01/014 06/0/016 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 8800 WASHINGTON AVE, SUITE 100 RACINE, WI 5406 Racine County Surveyor: William Rohner Lic #: 1180 GRETCHEN HULETZ Initial Cert: 10/01/1984 [email protected] Phone: (6) /01/015 09/0/017 Fax: (6) /01/015 09/0/017 CSSW - BURLINGTON, 480 S PINE, BURLINGTON, WI /01/015 09/0/017 SC JOHNSON ELEMENTARY SCHOOL, 40 KENTUCKY ST, RACINE, WI 5404 WADEWITZ ELEMENTARY SCHOOL, 700 YOUT ST, RACINE, WI /01/015 09/0/017 10/01/015 09/0/017 DEROSE FAMILY COUNSELING LLC 16 5TH STREET SUITE 1 RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 958 TALIA DEROSE Initial Cert: 0/07/01 [email protected] Phone: (6) /01/015 0/1/017 Fax: (6) /01/015 0/1/017 FAMILY SERVICE OF RACINE, INC. 40 SEVENTH STREET RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 19 JACK WOOD (CHIP) Initial Cert: 11/01/198 [email protected] Phone: (6) /01/015 1/1/016 Fax: (6) /01/015 1/1/016 11/4/015 age 16 of 186

137 HARVEST CONSULTING COMPANY, LLC 405 NORTHWESTERN AVE, LL15 RACINE, WI 5404 Racine County Surveyor: William Rohner Lic #: 98 CORIE HARGROVE Initial Cert: 11/0/01 Phone: (6) /01/014 11/0/015 Fax: (6) CSAS-AMBULATORY DETOXIFICATION DHS CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/015 07/01/014 11/0/015 07/01/014 11/0/015 HOPES CENTER OF RACINE, INC. 51 6TH STREET RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 97 SCOTT METZEL Initial Cert: 10/6/01 Phone: (6) /01/014 10/1/016 Fax: (6) LOVE INC COMMUNITY CENTER, 480 SOUTH PINE ST, BURLINGTON, WI /01/014 10/1/016 11/01/014 10/1/016 PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC LLC Lic #: WASHINGTON AVENUE, #110 RACINE, WI 5406 Racine County Surveyor: William Rohner ALICE PORTIS-PATTERSON Initial Cert: 0/05/008 [email protected] Phone: (6) /01/015 0/8/017 Fax: (6) /01/015 0/8/017 PSYCHIATRIC SERVICES OF RACINE LLP 144 WISCONSIN AVENUE #0 RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 1757 PATTI ROGINSKI Initial Cert: 05/01/1988 [email protected] Phone: (6) /01/014 10/1/016 Fax: (6) /01/014 10/1/016 RACINE COUNTY CCS 1717 TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 01 MICHELLE GOGGINS Initial Cert: 05/08/014 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 06/01/015 05/1/017 11/4/015 age 17 of 186

138 RACINE COUNTY HUMAN SERVICES DEPARTMENT Lic #: TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 01/14/004 Phone: (6) /01/015 1/1/016 Fax: (6) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/015 1/1/016 01/01/015 1/1/016 RACINE COUNTY HUMAN SERVICES DEPARTMENT COMMUNITY SUPPORT PROGRAM Lic #: TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 1/01/011 Phone: (6) /01/014 11/0/016 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/014 11/0/016 WHEATON FRANCISCAN HEALTHCARE ALL SAINTS MENTAL HEALTH & ADDICTION CARE Lic #: WISCONSIN AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner KAREN MOLNAR-SMITH Initial Cert: 07/01/1990 [email protected] Phone: (6) /01/014 06/0/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 06/0/016 07/01/014 06/0/016 01/06/015 06/0/016 01/06/015 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 408 FOUR MILE ROAD, RACINE, WI /06/015 06/0/016 1 WHEATON FRANCISCAN MEDICAL GROUP - NEUROLOGY, 805 B SPRING ST., RD FLOOR, RACINE, W 04//015 06/0/016 1 WHEATON FRANCISCAN MEDICAL GROUP - UNION GROVE, 110 MAIN STREET, UNION GROVE, WI 5 01/06/015 06/0/016 WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 805B SPRING STREET #40, RACINE, WI 540 WHEATON FRANCISCAN HEALTHCARE-SPRING STREET CAMPUS, 81 SPRING STREET, RACINE, W WHEATON FRANCISCAN MED GRP - FAMILY MED CLINIC, 807 SPRING ST., RD FLOOR NORTH, RAC WHEATON FRANCISCAN MED GRP-CENTER FOR ADDICTION, 805 B SPRNG STREET, LL-0, RACINE WHEATON FRANCISCAN MEDICAL GROUP-ALL SAINTS, 48 OLD GREEN BAY ROAD, RACINE, WI 54 01/06/015 06/0/016 08/01/015 06/0/016 0/04/015 06/0/016 08/01/015 06/0/016 08/01/015 06/0/016 11/4/015 age 18 of 186

139 LAKEVIEW CARE PARTNERS WISCONSIN 1701 SHARP ROAD WATERFORD, WI 5185 Racine County Surveyor: William Rohner Lic #: 94 DR. CYNTHIA SORENSON Initial Cert: 0/14/011 Phone: (6) /01/015 01/1/017 Fax: (6) /01/015 01/1/017 Ramsey County (MN) FAMILY INNOVATIONS, INC 10 B&C CTY RD D EAST MAPLEWOOD, MN Ramsey County (MN) Surveyor: Roderic Senn Lic #: 90 CHERYL LERFALD Initial Cert: 05/01/01 [email protected] Phone: (651) /17/015 04/0/016 Fax: (651) /17/015 04/0/016 1 FAMILY INNOVATIONS, INC, 15 MAIN STREET STE 05, BALSAM LAKE, WI /17/015 04/0/016 FAMILY INNOVATIONS, INC, 11 CARMICHAEL, HUDSON, WI FAMILY INNOVATIONS - UNITY SCHOOL, TH STREET, BALSAM LAKE, WI /17/015 04/0/016 04/17/015 04/0/016 HAZELDEN MENTAL HEALTH CENTERS ST. PAUL Lic #: 680 STEWART AVENUE SAINT PAUL, MN 5510 Ramsey County (MN) Surveyor: Roderic Senn SCOTT HESSELTINE Initial Cert: 11/19/00 [email protected] Phone: (651) /01/015 04/0/017 Fax: (651) /01/015 04/0/017 HAZELDEN CENTER CITY, 1551 PLEASANT VALLEY RD, CENTER CITY, MN /01/015 04/0/017 HAZELDEN PLYMOUTH, TH AVE. N, PLYMOUTH, MN /01/015 04/0/017 11/4/015 age 19 of 186

140 Richland County RICHLAND COUNTY HEALTH & HUMAN SERVICES Lic #: W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren MYRANDA CULVER Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 RICHLAND COUNTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 56 1 W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren MYRANDA CULVER Initial Cert: 01/01/005 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 07/01/014 1/1/015 01/01/014 06/0/014 11/4/015 age 140 of 186

141 Rock County BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER Lic #: W. HART ROAD BELOIT, WI 5511 Rock County Surveyor: William Rohner GREG AMMON Initial Cert: 07/01/1985 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1 BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI /01/014 11/0/016 1 JANESVILLE OCCUPATIONAL HEALTH, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI /01/014 11/0/016 BELOIT MEMORIAL HIGH SCHOOL, 15 4TH STREET, BELOIT, WI /01/014 11/0/016 FAMILY SERVICES OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INC. Lic #: COLLEGE STREET BELOIT, WI 5511 Rock County Surveyor: William Rohner JENNIFER WEIDNER Initial Cert: 06/01/1981 [email protected] Phone: (608) /01/015 05/1/017 Fax: (608) /01/015 05/1/017 ROCK COUNTY HUMAN SERVICES DEPARTMENT - BELOIT COMMUNITY SUPPORT PROGRAM Lic #: ECLIPSE CENTER BELOIT, WI 5511 Rock County Surveyor: Cynthia Lindgren AMY COTTINGTON Initial Cert: 09/01/1989 Phone: (608) /01/015 04/0/017 Fax: (608) 6-69 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/017 ASSOCIATES IN PSYCHOTHERAPY, LLC 4700 DRESSER DRIVE STE #100 JANESVILLE, WI 5546 Rock County Surveyor: Cynthia Lindgren Lic #: 1075 CAROL ANN WARD Initial Cert: 08/01/1980 [email protected] Phone: (608) /01/014 05/1/016 Fax: (608) /01/014 05/1/016 1 ASSOCIATES IN PSYCHOTHERAPY, 66 PARK AVENUE, BELOIT, WI /01/014 05/1/016 11/4/015 age 141 of 186

142 GENESIS COUNSELING SERVICES, LTD. ONE S MAIN STREET JANESVILLE, WI 5545 Rock County Surveyor: Cynthia Lindgren Lic #: 181 JAMES BURNS PHD Initial Cert: 07/01/1988 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/016 07/01/015 06/0/016 MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM Lic #: MINERAL POINT AVENUE JANESVILLE, WI 5548 Rock County Surveyor: William Rohner BELINDA WELLNITZ Initial Cert: 05/18/01 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 MERCY OPTIONS - MERCY HEALTH SYSTEMS 1000 MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner Lic #: 161 LISA USGAARD Initial Cert: 10/01/1984 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 14 of 186

143 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE Lic #: MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 01/01/199 Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 1 MERCY MALL CLINIC, 1010 N WASHINGTON, JANESVILLE, WI /01/014 1/1/015 1 MERCY CLINIC NORTH, 400 DEERFIELD DRIVE, JANESVILLE, WI /01/014 1/1/015 1 MERCY EAST CLINIC, 54 E MILWAUKEE STREET, JANESVILLE, WI /01/014 1/1/015 1 MERCY EDGERTON MEDICAL CENTER, 17 N MAIN ST, EDGERTON, WI /01/014 11/0/014 1 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MILTON, 75 S. JANESVILLE ST, MILTON, WI 556 1/01/014 1/1/015 1 MERCY OPTIONS-OUTPATIENT SERVICES, 507 W MAIN ST, WHITEWATER, WI /01/014 1/1/015 1 MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI /01/014 1/1/015 MERCY BELOIT CLINIC, 85 PRAIRIE AVENUE, BELOIT, WI 5511 MERCY EVANSVILLE CLINIC, 00 UNION STREET, EVANSVILLE, WI 556 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MERCYCARE, 580 N. WASHINGTON ST., JANESVILLE MERCY OPTIONS BH CLINIC - WALWORTH, N846 STATE ROAD 67, WILLIAMS BAY, WI /01/014 1/1/015 01/01/014 1/1/015 04/06/015 1/1/015 01/01/014 1/1/015 MERCY OPTIONS CHILD AND ADOLESCENT DAY TREATMENT Lic #: EAST COURT ST JANESVILLE, WI 5547 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 07/01/007 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: NORTH COUNTY HWY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATE FLANAGAN Initial Cert: 07/01/014 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 1 ROCK COUNTY COMPREHENSIVE COMMUNITY SVS, 11 SOUTH FRANKLIN ST, JANESVILLE, WI /01/015 06/0/016 11/4/015 age 14 of 186

144 ROCK COUNTY COUNSELING CENTER 11 S FRANKLIN STREET JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren Lic #: 1807 KATE FLANNAGAN Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 1 ROCK CNTY CNSLNG CTR - HEALTHCARE CTR BRANCH, 50 N COUNTY TRK HWY F, JANESVILLE, W 09/01/014 08/1/016 1 ROCK COUTNY JOB CENTER, 1900 CENTER AVENUE, JANESVILLE, WI /01/015 08/1/016 COURT STREET BRANCH OFFICE, 0 W. COURT ST., JANESVILLE, WI 5548 ROCK CNTY CNSLNG CTR - BELOIT BRANCH, 64 ECLIPSE CENTER, BELOIT, WI /7/015 08/1/016 09/01/014 08/1/016 ROCK COUNTY HUMAN SERVICES CRISIS INTERVENTION UNIT Lic #: N COUNTY HIGHWAY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATHERINE FLANAGAN Initial Cert: 01/10/1975 [email protected] Phone: (608) /01/015 08/1/016 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/015 08/1/016 ROCK COUNTY HUMAN SERVICES DEPARTMENT - JANESVILLE COMMUNITY SUPPORT PROGRAM Lic #: S FRANKLIN ST JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren AMY COTTINGTON Initial Cert: 09/01/1989 Phone: (608) /01/015 04/0/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/017 ROCK VALLEY COMMUNITY PROGRAMS INC 0 W SUNNY LANE ROAD JANESVILLE, WI 5546 Rock County Surveyor: William Rohner Lic #: 1809 ANGEL EGGERS Initial Cert: 0/01/1990 [email protected] Phone: (608) /01/014 0/9/016 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 JANESVILLE PSYCHIATRIC CLINIC, 15 W. MILWAUKEE ST., #07, JANESVILLE, WI /5/015 0/9/016 11/4/015 age 144 of 186

145 TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: S RIVER STREET #54 JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren TIM PERRY Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 1 CROSSROADS COUNSELING CENTER, 778 LOIS DRIVE, SUN PRAIRIE, WI /01/015 09/0/017 Rusk County ACCESS, INC COMMUNITY SUPPORT PROGRAM Lic #: W ND STREET N LADYSMITH, WI Rusk County Surveyor: Polly Wong ANDY WOLF Initial Cert: 09/06/011 [email protected] Phone: (715) /01/015 08/1/017 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 09/01/015 08/1/017 09/01/015 08/1/017 RUSK COUNTY HEALTH & HUMAN SERVICES/ACCESS, INC. Lic #: E MINER AVENUE LADYSMITH, WI Rusk County Surveyor: Polly Wong JEREMY JACOBS Initial Cert: 05/16/006 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) 5-16 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 11/4/015 age 145 of 186

146 Saint Croix County BALDWIN AREA MEDICAL CENTER INC 70 10TH AVENUE BALDWIN, WI 5400 Saint Croix County Surveyor: Roderic Senn Lic #: 946 CHRISTOPHER BABBITT Initial Cert: 07/0/011 Phone: (715) /01/014 06/0/016 Fax: (715) /01/014 06/0/016 1 BALDWIN AREA MED CNTR-NORTHWEST COUNSL, 50 SECOND ST #0, HUDSON, WI /01/014 06/0/016 HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE Lic #: DOMINION DRIVE HUDSON, WI Saint Croix County Surveyor: Roderic Senn PETER VAN DUSARTZ Initial Cert: 09/01/1990 Peter.J.Vandusartz@HudsonHospita Phone: (715) /01/015 11/0/017 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 11/0/017 1/01/015 11/0/017 1 HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI /01/015 11/0/017 1 WESTFIELDS HOSPITAL, 55 HOSPITAL ROAD, NEW RICHMOND, WI /01/015 11/0/017 MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: ENLOE STREET UNIT 4 HUDSON, WI Saint Croix County Surveyor: Roderic Senn THOMAS E JOHNSTON Initial Cert: 05/01/009 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 05/01/014 04/0/016 FAMILY THERAPY ASSOCIATES LLC 1477 S KNOWLES AVE STE 10 NEW RICHMOND, WI Saint Croix County Surveyor: Roderic Senn Lic #: 07 JAMIE MASON Initial Cert: 1/04/014 [email protected] Phone: (715) /04/014 11/0/015 Fax: (715) /04/014 11/0/015 1 FAMILY THERAPY ASSOCIATES, LLC, 50 S WASHINGTON ST, STE 110, SAINT CROIX FALLS, WI /15/015 11/0/015 ST CROIX FALLS ELEMENTARY SCHOOL, 651 E LOUISIANA, ST CROIX FALLS, WI 5404 ST CROIX FALLS MIDDLE & HIGH SCHOOL, 740 MAPLE DR, ST CROIX FALLS, WI /04/014 11/0/015 1/04/014 11/0/015 11/4/015 age 146 of 186

147 ST. CROIX COUNTY HEALTH & HUMAN SERVICES - BEHAVIORAL HEALTH Lic #: DORSET LANE NEW RICHMOND, WI Saint Croix County Surveyor: Roderic Senn KATHY HUSTON Initial Cert: 01/01/1990 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/014 11/0/016 ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH Lic #: DORSET LANE NEW RICHMOND, WI Saint Croix County Surveyor: Roderic Senn STEVE KIRT Initial Cert: 10/01/1975 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 11/4/015 age 147 of 186

148 Saint Louis County (MN) ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER Lic #: EAST SECOND STREET DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong DONNA CRIDER Initial Cert: 09/01/1987 Phone: (18) /01/015 11/0/016 Fax: (18) 7-07 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 11/0/016 01/01/015 11/0/016 ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER Lic #: PECAN AVENUE DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 10/01/1998 Phone: (18) /01/015 11/0/016 Fax: (18) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 01/01/015 11/0/016 SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH Lic #: 0 0 EAST ND STREET DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 0/5/014 [email protected] Phone: (18) /01/015 01/1/016 Fax: (18) MENTAL HEALTH-DAY TREATMENT DHS /01/015 01/1/016 SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH CLINIC Lic #: EAST ND STREET DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 0/06/01 [email protected] Phone: (18) /01/014 0/9/016 Fax: (18) /01/014 0/9/016 1 ESSENTIA HLTH ST.MARY'S HOSPITAL & CLINIC SUPERIOR, 500 TOWER AVENUE, SUPERIOR, WI 54 0/01/014 0/9/016 ST. LUKE'S HOSPITAL 915 E. FIRST STREET DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong Lic #: 1865 KATHLEEN FOREMAN Initial Cert: 0/01/1995 [email protected] Phone: (18) /01/015 01/1/017 Fax: (18) MENTAL HEALTH-INPATIENT DHS /01/015 01/1/017 11/4/015 age 148 of 186

149 Sauk County INNERVISIONS COUNSELING AND CONSULTING CENTER, SC Lic #: ELIZABETH STREET BARABOO, WI 591 Sauk County COLLEEN S. JAMES Initial Cert: 11/19/007 Phone: (608) /01/014 10/1/016 Fax: (877) /01/014 10/1/016 1 INNERVISIONS COUNSELING & CONSULTING CENTER, 1 EAST STATE ST, MAUSTON, WI /01/014 10/1/016 1 NECEDAH FAMILY MEDICAL CENTER, 1408 WHEELIHAN AVE, NECEDAH, WI /01/014 10/1/016 1 NEW LISBON FAMILY MEDICAL CENTER, 901 WEST BRIDGE STREET, NEW LISBON, WI /01/014 10/1/016 DELTON FAMILY MEDICAL CENTER, 8 COMMERCE ST., WISCONSIN DELLS, WI 5965 MILE BLUFF CLINIC, 1040 DIVISION ST., MAUSTON, WI 5948 JACK YOUNG MIDDLE SCHOOL, 151 DRAPER ST, BARABOO, WI 591 OLSON MIDDLE SCHOOL, 508 GRAYSIDE AVENUE, MAUSTON, WI /1/016 10/1/016 11/01/014 10/1/016 1/04/014 10/1/016 0/4/015 10/1/016 SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: BROADWAY BARABOO, WI 591 Sauk County SHARON BOESL Initial Cert: 0/01/007 [email protected] Phone: (608) /01/015 0/8/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 1 SAUK COUNTY DEPT HUMAN SERVICES REEDSBURG, 45-6TH STREET, REEDSBURG, WI /01/015 0/8/017 SAUK COUNTY DEPARMENT OF HUMAN SERVICES Lic #: BROADWAY STREET BARABOO, WI 591 Sauk County SHARON BOESL Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 SAUK COUNTY DHS - REEDSBURG OFFICE, 45 SIXTH STREET, REEDSBURG, WI /01/014 1/1/015 11/4/015 age 149 of 186

150 ST. CLARE CENTER, ST. CLARE HOSPITAL 1510 JEFFERSON STREET BARABOO, WI 591 Sauk County Lic #: 087 JUDY HANNAFORD Initial Cert: 11/5/1998 Phone: (608) /01/014 01/1/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS /01/014 01/1/016 0/01/014 04/0/015 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 PATHWAY CLINIC SC 560-4TH STREET PRAIRIE DU SAC, WI 5578 Sauk County Lic #: 179 TAMMY KIRCH Initial Cert: 09/01/1984 Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 GOODMAN'S BEHAVIORAL HEALTH CLINIC LLC ST STREET SUITE E REEDSBURG, WI 5959 Sauk County Lic #: 774 BARBARA GOODMAN Initial Cert: 0/06/008 [email protected] Phone: (608) /01/015 0/8/017 Fax: (608) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: SIXTH STREET REEDSBURG, WI 5959 Sauk County ANGELA TOURDOT Initial Cert: 07/01/1990 [email protected] Phone: (608) /01/014 06/0/016 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 11/4/015 age 150 of 186

151 Sawyer County COUNSELING AND PSYCHOLOGICAL SERVICES LLC Lic #: W COUNTY HWY B HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong CONSTANCE NEWMAN Initial Cert: 04/01/01 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) CAPS - HURLEY OFFICE, 09 W. SILVER STREET, HURLEY, WI /01/015 0/1/017 04/01/015 0/1/017 COUNSELING & PSYCHOLOGICAL SVS, 01 S ELLIS AVE, ASHLAND, WI CAPS - BUTTERNUT, 1 WEST WISCONSIN STREET, BUTTERNUT, WI CAPS - MELLEN SCHOOL DISTRICT, 40 S. MAIN ST, MELLEN, WI CAPS - NORTHWOOD SCHOOL, N1446 HWY 5, MINONG, WI /01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 LAC COURTE ORIELLES COMMUNITY HEALTH CENTER Lic #: W TREPANIA ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong JENNY INGRAM Initial Cert: 0/01/1987 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHWEST OASIS, US HWY 6, HAYWARD, WI /01/014 06/0/016 LAC COURTE OREILLES OJIBWE SCHOOL, 8575 N. TREPANIA ROAD, HAYWARD, WI /01/014 06/0/016 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM Lic #: OLKER ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong CAROL LUND Initial Cert: 0/01/001 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) 64-5 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 09/01/014 08/1/016 NORTHLAND COUNSELING SERVICES LTD 1075 BEAL STREET HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong Lic #: 1 CAROL LUND Initial Cert: 04/0/000 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) NORTHLAND COUNSELING SERVICES LTD, US HWY 6, HAYWARD, WI /01/014 0/1/016 04/01/014 0/1/016 11/4/015 age 151 of 186

152 NORTHWEST JOURNEY - HAYWARD 1609 US HIGHWAY 6 HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong Lic #: 049 ANNE WOLLAN Initial Cert: 09/16/014 [email protected] Phone: (715) /01/015 08/1/017 Fax: (175) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/017 09/01/015 08/1/017 SAWYER COUNTY HUMAN SERVICES/NORTHLAND COUNSELING SERVICES Lic #: OLKER ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong PAUL G. GRAHOVAC Initial Cert: 10/01/01 [email protected] Phone: (715) /01/015 09/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/015 09/0/016 11/4/015 age 15 of 186

153 Shawano County STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER Lic #: 188 W180 COUNTY HWY A BOWLER, WI Shawano County NANCY MILLER-KORTH Initial Cert: 06/19/014 Phone: (715) /01/015 07/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 07/1/016 08/01/015 07/1/016 MAEHNOWESEKIYAH WELLNESS CENTER N150 KESAEHKAHTEK GRESHAM, WI 5418 Shawano County Lic #: 1554 PILAR GAUTHIER Initial Cert: 11/1/1989 [email protected] Phone: (715) /01/015 11/0/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS /01/015 11/0/016 1/01/015 11/0/016 1/01/015 11/0/016 1/01/015 11/0/016 SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER Lic #: LAKELAND ROAD SHAWANO, WI Shawano County JESSICA DELZER Initial Cert: 0/01/1977 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER Lic #: LAKELAND ROAD SHAWANO, WI Shawano County KELLY BUESCHEL Initial Cert: 01/01/000 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/0/015 1/1/016 01/01/015 1/1/016 11/4/015 age 15 of 186

154 SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS Lic #: LAKELAND ROAD SHAWANO, WI Shawano County JESSICA DELZER Initial Cert: 05/06/014 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 154 of 186

155 Sheboygan County AURORA SHEBOYGAN CLINIC 414 KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 195 TRACY LEE-JOHNSON Initial Cert: 07/01/1986 Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 1 AURORA SHEBOYGAN CLINIC, 600 KILEY WAY, PLYMOUTH, WI /01/014 06/0/016 AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER Lic #: N 7TH STREET SHEBOYGAN, WI 508 Sheboygan County LORI KNITT Initial Cert: 05/01/1987 [email protected] Phone: (90) /01/014 04/0/016 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. Lic #: WISCONSIN AVENUE SHEBOYGAN, WI 5081 Sheboygan County MANDY BIBO Initial Cert: 04/01/198 [email protected] Phone: (90) /01/015 04/0/017 Fax: (90) CATHOLIC CHARITIES ARCHDIOCESE OF MILW INC, 191 S MAIN STREET, FOND DU LAC, WI /01/015 04/0/017 05/01/015 04/0/017 LEPAK JOSTSONS INC DBA DYNAMIC FAMILY SOLUTIONS Lic #: SOUTH 8TH ST SUITE 0 SHEBOYGAN, WI 5081 Sheboygan County JANE A LEPAK JOSTSONS Initial Cert: 08/19/009 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) /01/014 08/1/016 DYNAMIC FAMILY SOLUTIONS - STURGEON BAY, 101 NORTH 4TH AVENUE, STURGEON BAY, WI 54 09/01/014 08/1/016 DYNAMIC FAMILY SOLUTIONS, 01 HOLMGREN WAY, GREEN BAY, WI /01/014 08/1/016 DYNAMIC FAMILY SOLUTIONS, ONE WALDO BLVD SUITE, MANITOWOC, WI /01/014 08/1/016 11/4/015 age 155 of 186

156 NETT-WORK FAMILY COUNSELING, LLC 801 CALUMET DRIVE SHEBOYGAN, WI 508 Sheboygan County Lic #: 1656 CHRISTINE L. NETT Initial Cert: 0/7/1998 Phone: (90) /01/014 0/9/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, TH STREET #1, MANITOWOC, WI 540 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 140 MILWAUKEE DR, NEW HOLSTEIN, WI /01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 61 E MILL ST, PLYMOUTH, WI 507 0/01/014 0/9/016 NETT-WORK FAMILY COUNSELING, LLC, 1 SOUTH 1TH ST, SHEBOYGAN, WI /01/014 0/9/016 NORTHSHORE CLINIC LLC 805 NORTH 6TH STREET SHEBOYGAN, WI 5081 Sheboygan County Lic #: 1699 LORI DIELENTHEIS Initial Cert: 08/01/1991 [email protected] Phone: (90) /01/014 01/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 01/1/016 0/01/014 01/1/016 SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County JODY A GALLAWAY, PSYD Initial Cert: 07/01/1986 [email protected] Phone: (90) /01/014 09/0/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CSP Lic #: NORTH 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County ERIC BRUNNICH Initial Cert: 07/01/1996 [email protected] Phone: (90) /01/01 09/0/015 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/01 09/0/015 11/4/015 age 156 of 186

157 SHEBOYGAN COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County AMY CULVER Initial Cert: 05/01/006 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 05/1/016 06/01/014 1/1/014 ST. NICHOLAS HOSPITAL DBA PREVEA HEALTH 45 SUPERIOR AVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 070 JEFF STUMBRAS Initial Cert: 10/7/014 [email protected] Phone: (90) /01/015 11/0/017 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 11/0/017 1/01/015 11/0/017 11/4/015 age 157 of 186

158 Taylor County ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. 14 SOUTH GIBSON ST MEDFORD, WI Taylor County Surveyor: Polly Wong Lic #: 1577 ROBB FABICH Initial Cert: 01/01/1978 Phone: (715) /01/015 08/1/017 Fax: (715) /01/015 08/1/017 1 ASPIRUS PHILLIPS CLINIC, 65 PETERSON AVE, PHILLIPS, WI /01/015 08/1/017 1 ASPIRUS PRENTICE CLINIC, 1511 RAILROAD AVE, PRENTICE, WI /01/015 08/1/017 COUNSELING CONNECTION OF MEDFORD 1 WEST STATE STREET, #4 MEDFORD, WI Taylor County Surveyor: Polly Wong Lic #: 75 KELLY SCHULTZ Initial Cert: 09/01/007 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 1 CADOTT MEDICAL CENTER-COUNSELING CONNECTION, NORTH MAIN ST, CADOTT, WI /01/014 08/1/016 1 PHOENIX HOUSE, 600 W. HICKORY STREET, GILMAN, WI /1/016 08/1/016 COLBY MIDDLE SCHOOL, 70 NORTH ND ST, COLBY, WI 5441 MEDFORD ELEMENTARY SCHOOL-COUNSELING CONNECTION, 1065 W BROADWAY AVE, MEDFORD, MEDFORD MIDDLE SCHOOL-COUNSELING CONNECTION, 509 CLARK ST, MEDFORD, WI /01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 NORTH CENTRAL COUNSELING CENTER 16 W. BROADWAY MEDFORD, WI Taylor County Surveyor: Polly Wong Lic #: 1675 DEBRA KOLTIS Initial Cert: 1/01/1994 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) /01/015 06/0/017 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT Lic #: E. COLLEGE STREET MEDFORD, WI Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 06/01/198 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 11/4/015 age 158 of 186

159 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT CCS PROGRAM Lic #: E COLLEGE ST MEDFORD, WI Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 07/01/015 [email protected] Phone: (715) /01/015 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 Trempealeau County MAYO CLINIC FRANCISCAN HEALTH CARE COMMUNITY SUPPORT PROGRAM Lic #: S. ST. JOSEPHS AVENUE ARCADIA, WI 5461 Trempealeau County Surveyor: Roderic Senn JANET BUTLER Initial Cert: 0/01/199 [email protected] Phone: (608) /01/015 0/8/017 Fax: (608) -05 MENTAL HEALTH-COM SUPPORT PROGRAM W/TELEHEALTH DHS 6 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/015 0/8/017 0/01/015 0/8/017 WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC Lic #: WHITEHALL RD INDEPENDENCE, WI Trempealeau County Surveyor: Roderic Senn TODD PYKA Initial Cert: 09/0/004 [email protected] Phone: (715) /01/015 08/1/017 Fax: (715) 84-8 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 TREMPEALEAU COUNTY HUMAN SERVICES - CCS Lic #: MAIN ST WHITEHALL, WI 5477 Trempealeau County Surveyor: Roderic Senn DEBRA SUCHLA Initial Cert: 09/01/015 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/015 08/1/016 09/01/015 08/1/016 11/4/015 age 159 of 186

160 Vernon County CENTER POINT COUNSELING SERVICES COOPERATIVE Lic #: AIRPORT RD SUITE 10 VIROQUA, WI Vernon County SHERI HAMMOND Phone: (608) Fax: (608) Initial Cert: 1/01/ BETHEL HOME & SERVICES, 614 SOUTH ROCK AVENUE, VIROQUA, WI BETHEL HOME & SERVICES, 60 SOUTH GARFIELD, VIROQUA, WI CENTER POINT CNSLNG SVS VERNON MANOR, E7404A COUNTY ROAD BB, VIROQUA, WI COON VALLEY ELEMENTARY SCHOOL, 00 LIEN STREET, COON VALLEY, WI 546 VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DRIVE, VIROQUA, WI VIROQUA ELEMENTARY SCHOOL, 115 NORTH EDUCATION AVE, VIROQUA, WI WESTBY ELEMENTARY SCHOOL, 1 NELSON STREET, WESTBY, WI WESTBY MIDDLE & HIGH SCHOOL, 06 WEST AVENUE SOUTH, WESTBY, WI FAMILY AND CHILDREN'S CENTER, INC. COMMUNITY SUPPORT PROGRAM Lic #: N MAIN ST VIROQUA, WI Vernon County Surveyor: Roderic Senn SUZIE HOWE Initial Cert: 01/01/1996 [email protected] Phone: (608) /01/015 04/0/017 Fax: (608) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/017 PSYCHIATRIC ASSOCIATES COUNSELING CENTER LLC Lic #: W SOUTH STREET VIROQUA, WI Vernon County Surveyor: Roderic Senn JULIE NOTH Initial Cert: 08/01/1987 [email protected] Phone: (608) /01/014 05/1/016 Fax: (608) /01/014 05/1/016 1 PSYCHIATRIC ASSOCIATES COUNSELING CENTER, 66 EAST AVENUE SOUTH, LA CROSSE, WI /01/014 05/1/016 STRIVE COMPREHENSIVE COMMUNITY SERVICES Lic #: FAIRLANE DRIVE SUITE 100 VIROQUA, WI Vernon County Surveyor: Roderic Senn REBECCA MILLER Initial Cert: 08/01/015 [email protected] Phone: (608) /01/015 07/1/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 08/01/015 07/1/016 CRAWFORD CO DEPT. OF HUMAN SERVICES, 5 N. BEAUMONT RD SUITE 6, PRAIRIE DU CHIEN, W 08/01/015 07/1/016 11/4/015 age 160 of 186

161 VERNON COUNTY DEPT OF HUMAN SERVICES/CENTER POINT COUNSELING SERVICES COOP Lic #: AIRPORT RD, SUITE 10 VIROQUA, WI Vernon County Surveyor: Roderic Senn PAM EITLAND Initial Cert: 1/01/011 Phone: (608) /01/014 11/0/016 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 HIDDEN SPRINGS CLINIC S 1597 HANSON ROAD WESTBY, WI Vernon County Surveyor: Roderic Senn Lic #: 565 DEAN JENSEN Initial Cert: 1/09/004 [email protected] Phone: (608) /01/014 06/0/016 Fax: (608) /01/014 06/0/016 Vilas County FAMILY RESOURCE CENTER 5 PEACE PIPE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong Lic #: 15 DENISE WILDCAT Initial Cert: 09/01/1988 [email protected] Phone: (715) /01/015 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/015 11/01/015 1/1/015 1 DOMESTIC ABUSE PROGRAM, 157 CEDAR AVENUE, LAC DU FLAMBEAU, WI /06/016 1/1/015 1 SOBER HOME - MEN'S, 119 ARNOLD STOCK ROAD, LAC DU FLAMBEAU, WI /06/016 1/1/015 1 SOBER HOME - WOMEN'S, 55 BOBIDOSH POINT LANE, LAC DU FLAMBEAU, WI /06/016 1/1/015 LAC DU FLAMBEAU PUBLIC SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI 5458 LAKELAND UNION HIGH SCHOOL, 957 STATE HWY 70, MINOCQUA, WI /01/015 1/1/015 11/01/015 1/1/015 LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS Lic #: OLD ABE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong RYAN CHAMPAGNE Initial Cert: 0/01/015 [email protected] Phone: (715) /01/015 01/1/016 Fax: (715) CCS REGIONAL MODEL POPULATION-BASED DHS 6 0/01/015 01/1/016 11/4/015 age 161 of 186

162 Walworth County CREDENCE THERAPY ASSOCIATES 1-1/ W. GENEVA STREET ELKHORN, WI 511 Walworth County Surveyor: William Rohner Lic #: 16 KIM STEEN Initial Cert: 1/19/1995 Phone: (6) /01/014 11/0/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1 CREDENCE THERAPY ASSOCIATES, 066 WEST MAIN ST UNIT #106, EAST TROY, WI 510 1/01/014 11/0/016 BADGER HIGH SCHOOL, 0 E. SOUTH STREET, LAKE GENEVA, WI 5147 BIG FOOT HIGH SCHOOL, 401 DEVILS LANE PO BOX 99, WALWORTH, WI 5184 DELAVAN-DARIEN HIGH SCHOOL, 150 CUMMINGS ST, DELAVAN, WI 5115 ELKHORN AREA HIGH SCHOOL, 48 EAST GENEVA STREET, ELKHORN, WI 511 ELKHORN AREA MIDDLE SCHOOL, 67 EAST COURT ST., ELKHORN, WI 511 JACKSON ELEMENTARY SCHOOL, 1 NORTH JACKSON STREET, ELKHORN, WI 511 LAKE GENEVA MIDDLE SCHOOL, 600 BLOOMFIELD ROAD, LAKE GENEVA, WI 5147 SHARON COMMUNITY SCHOOL, 104 E. SCHOOL ST, SHARON, WI 5585 TIBBETS ELEMENTARY SCHOOL, W518 COUNTY ROAD A, ELKHORN, WI 511 WEST SIDE ELEMENTARY SCHOOL, SUNSET DRIVE, ELKHORN, WI /1/015 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 06/0/015 11/0/016 06/0/015 11/0/016 06/0/015 11/0/016 10/1/015 11/0/016 0/09/015 11/0/015 06/0/015 11/0/016 06/0/015 11/0/016 WALWORTH COUNTY DEPT OF HEALTH & HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 694 W4051 COUNTY ROAD NN ELKHORN, WI 511 Walworth County Surveyor: William Rohner LISA KADLEC Initial Cert: 11/08/006 [email protected] Phone: (6) /01/015 11/0/017 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 WALWORTH COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES Lic #: 889 W4051 COUNTY ROAD NN ELKHORN, WI 511 Walworth County Surveyor: William Rohner LISA KADLEC Initial Cert: 01/0/010 [email protected] Phone: (6) /01/015 01/1/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 01/1/017 11/4/015 age 16 of 186

163 WALWORTH COUNTY HEALTH AND HUMAN SERVICES Lic #: 1967 W4051 COUNTY TRUNK NN ELKHORN, WI 511 Walworth County Surveyor: William Rohner CARLO NEVICOSI Initial Cert: 10/01/1975 Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES - LAKE GENEVA Lic #: E GENEVA SQUARE LAKE GENEVA, WI 5147 Walworth County Surveyor: William Rohner KATE CONNELLY Initial Cert: 0/01/004 [email protected] Phone: (6) /01/015 01/1/017 Fax: (6) AMG BEHAVIORAL HEALTH SERVICES-ELKHORN, 01 E. MORRISEY DRIVE, ELKHORN, WI AURORA HEALTH CENTER - DELAVAN, 1550 HOBBS DRIVE, DELAVAN, WI /01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 LAKE GENEVA WELLNESS CLINIC Lic #: BROAD STREET, #01 LAKE GENEVA, WI 5147 Walworth County Surveyor: William Rohner ERIKA FOUNTAIN Initial Cert: 0/01/1984 [email protected] Phone: (6) /01/015 0/1/017 Fax: (6) /01/015 0/1/017 WHEATLAND CENTER SCHOOL, TH AVENUE, BURLINGTON, WI /09/015 0/1/017 11/4/015 age 16 of 186

164 Washburn County SOAR SERVICES, INC. 46 INDUSTRIAL DRIVE SHELL LAKE, WI Washburn County Surveyor: Polly Wong Lic #: 506 MICHAEL TURGEON Initial Cert: 0/11/004 Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 SOAR COUNSELING SERVICES, 517 BEASER AVENUE, ASHLAND, WI /01/014 0/1/016 ACCESS, INC HWY 6 SOUTH SPOONER, WI Washburn County Surveyor: Polly Wong Lic #: 61 ANDREW WOLF Initial Cert: 01/01/006 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/014 1/1/015 08/01/014 1/1/015 01/01/014 1/1/015 08/01/014 1/1/015 1 ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 10 ARLEN CT, EAU CLAIRE, WI /01/014 1/1/015 1 ACCESS, INC, 100 POLK COUNTY PLAZA, #70, BALSAM LAKE, WI /01/014 1/1/015 1 ACCESS, INC, 0 E LASALLE STREET, BARRON, WI /01/014 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 555 JENSON DR., MEDFORD, WI /1/016 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 915 INDIANHEAD DR., MOSINEE, WI /01/014 10/01/014 ACCESS, INC - LADYSMITH, 108 W. ND STREET N, LADYSMITH, WI ACCESS, INC - LADYSMITH, 804 W 9TH STREET N, SUITE B, LADYSMITH, WI ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 406 TECHNOLOGY DR. E SUITE C, MENOMON ACCESS, INC. - SIREN, 4670 STATE ROAD 5/70, #100, SIREN, WI 5487 ACCESS INC SPOONER-MIDDLE/HIGH SCHOOL, 500 COLLEGE AVE., SPOONER, WI ACCESS INC-LADYSMITH ELEMENTARY SCHOOL, 64 EAST 6TH STREET, LADYSMITH, WI ACCESS, INC - BRUCE MIDDLE SCHOOL, 104 W WASHINGTON AVE, BRUCE, WI ACCESS, INC - SPOONER MIDDLE SCHOOL, 750 OAK STREET, SPOONER, WI ACCESS, INC-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET SOUTH, LADYSMITH, WI ACCESS, INC-SCHOOL DISTRICT OF FLAMBEAU, N 4540 CTY HWY I, TONY, WI 5456 GRANTSBURG MIDDLE/SENIOR HIGH SCHOOL, 480 EAST JAMES AVENUE, GRANTSBURG, WI /0/015 1/1/015 08/01/014 08/0/015 08/01/014 1/1/015 08/01/014 1/1/015 01/01/014 05/1/014 08/01/014 1/1/015 11/09/016 1/1/015 06/01/014 1/1/015 08/01/014 1/1/015 08/01/014 1/1/015 08/01/014 1/1/015 WASHBURN COUNTY COMMUNITY SUPPORT PROGRAM Lic #: FRONT STREET SPOONER, WI Washburn County Surveyor: Polly Wong MS. ANJULI (AJ) SIMON Initial Cert: 11/01/010 [email protected] Phone: (715) /01/015 10/1/017 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 11/4/015 age 164 of 186

165 Washington County WI LUTHERAN CHILD & FAMILY SERVICE, INC. D/B/A CHRISTIAN FAMILY COUNSELING Lic #: 1199 W175 N1110 STONEWOOD DR GERMANTOWN, WI 50 Washington County MYLES TONNACLIFF Initial Cert: 1/01/1987 Phone: (6) /01/014 11/0/016 Fax: (6) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/014 11/0/016 1/01/014 11/0/016 1 CFC - ST MARTINI, 150 S. CESAR CHAVEZ DRIVE, MILWAUKEE, WI /0/015 11/0/016 1 CHRISTIAN FAMILY COUNSELING - NEW BEGINNINGS, 915 W. WISCONSIN AVE., MILWAUKEE, WI 5 0/0/016 11/0/016 1 CHRISTIAN FAMILY COUNSELING-RISEN SAVIOR, 9505 BROWN DEER RD, MILWAUKEE, WI 54 1/01/014 11/0/016 1 THE BEACON BUILDING, W NORTH AVENUE, #0, BROOKFIELD, WI /01/014 11/0/016 1 WLCFS-CHRISTIAN FAMILY COUNSELING, 9555 S HOWELL AVENUE, #750, OAK CREEK, WI /01/014 08/9/015 WLCFS-CHRISTIAN FAMILY COUNSELING, 10 N MAIN STREET SUITE 40, WEST BEND, WI 5095 CFC - HOPE HIGH SCHOOL, 15 N DR. MARTIN LUTHER KING JR. DRIVE, MILWAUKEE, WI 51 CFC - LUMIN 1 - GRANVILLE, 84 N. GRANVILLE ROAD, MILWAUKEE, WI 54 CFC - LUMIN - NORTHWEST, 4119 N. 81ST STREET, MILWAUKEE, WI 5 CFC - LUMIN - PILGRIM, 6717 WEST CENTER STREET, MILWAUKEE, WI 510 CFC - LUMIN 4 - ST. MARTINI, 150 S. CESAR CHAVEZ DRIVE, MILWAUKEE, WI 504 CFC - LUMIN 5 - SHERMAN PARK, 70 N. SHERMAN ROAD, MILWAUKEE, WI 510 CFC - LUMIN 6 - RENNAISSANCE, 6150 TAYLOR AVENUE, RACINE, WI 540 CFC - RISEN SAVIOR SCHOOL, 9550 W. BROWN DEER ROAD, MILWAUKEE, WI 54 CFC - SHINING STAR, 4050 N. 95TH STREET, MILWAUKEE, WI 5 CFC - SHORELAND LHS, 906 1TH STREET, SOMERS, WI 5171 HOPE FORTIS SCHOOL, 601 N PORT WASHINGTON ROAD, MILWAUKEE, WI 51 HOPE PRIMA SCHOOL, 45 N 5TH STREET, MILWAUKEE, WI 506 ST MARCUS SCHOOL, 15 N. PALMER STREET, MILWAUKEE, WI 51 ST PETER LUTHERAN SCHOOL, 114 S 8TH STREET, MILWAUKEE, WI 504 ST. PETER LUTHERAN SCHOOL, 9 W. GREENFIELD AVE, MILWAUKEE, WI 504 1/01/014 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 08/01/015 11/0/016 07/1/016 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 09/0/015 09/1/015 11/0/016 GENESIS BEHAVIORAL SERVICES HARTFORD OUTPATIENT CLINIC Lic #: E. SUMNER STREET HARTFORD, WI 507 Washington County GINA SINGLETERY Initial Cert: 04/01/1994 [email protected] Phone: (6) /01/014 0/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 11/4/015 age 165 of 186

166 FAMILYMEANS 1875 NORTHWESTERN AVENUE, S. STILLWATER, MN 5508 Washington County (MN) Surveyor: Roderic Senn Lic #: 14 PATRICIA ROGERS Initial Cert: 0/01/1989 Phone: (651) /01/014 04/0/016 Fax: (651) /01/014 04/0/016 1 FAMILYMEANS, 17 VINE STREET, #105, HUDSON, WI /01/014 04/0/016 HUDSON HIGH SCHOOL, 1501 VINE ST., HUDSON, WI HUDSON MIDDLE SCHOOL, 100 CARMICHAEL RD, HUDSON, WI NEW RICHMOND HIGH SCHOOL, 650 RICHMOND WAY, NEW RICHMOND, WI ROCK ELEMENTARY SCHOOL, 40 1TH ST. N, HUDSON, WI /7/016 04/0/016 04/7/016 04/0/016 04/7/016 04/0/016 04/7/016 04/0/016 AFFILIATED CLINICAL SERVICES INC 111 E WASHINGTON STREET WEST BEND, WI 5095 Washington County Lic #: 1017 DEBRA PIETSCH Initial Cert: 10/01/1984 [email protected] Phone: (6) /01/015 06/0/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/015 06/0/016 06/01/015 06/0/016 AFFILIATED CLINICAL SERVICES INC, 8 SELL DRIVE #B, HARTFORD, WI /01/015 06/0/016 WEST BEND EAST & WEST HIGH SCHOOL, 105 E. DECORAH RD., RM N 15, WEST BEND, WI /01/015 06/0/016 GENESIS BEHAVIORAL SERVICES, INC. WEST BEND OUTPATIENT CLINIC Lic #: CLARENCE COURT WEST BEND, WI 5095 Washington County GINA SINGLETERY Initial Cert: 01/01/1987 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 GENESIS BEHAVIORAL SERVICES, INC, W175 N1116 STONEWOOD DRIVE, #08, GERMANTOWN, WI 01/01/014 1/1/015 WASHINGTON COUNTY MENTAL HEALTH CENTER Lic #: 1968 E WASHINGTON ST #000 WEST BEND, WI 5095 Washington County MAUREEN MURPHY Initial Cert: 10/01/1975 [email protected] Phone: (6) /01/015 04/0/017 Fax: (6) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/015 04/0/017 05/01/015 04/0/017 11/4/015 age 166 of 186

167 WASHINGTON COUNTY MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM Lic #: 0 E. WASHINGTON ST SUITE 100 WEST BEND, WI 5095 Washington County ERIC DIAMOND Initial Cert: 10/01/1975 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/014 04/0/016 WASHINGTON COUNTY MENTAL HEALTH CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: 580 E WASHINGTON STREET, #100 WEST BEND, WI 5095 Washington County ERIC DIAMOND Initial Cert: 0/01/005 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 0/9/016 0/01/014 1/1/014 11/4/015 age 167 of 186

168 Waukesha County CORNERSTONE COUNSELING SERVICES, INC W. BLUEMOUND ROAD, #00 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 17 SANDRA ADAMS Initial Cert: 0/01/199 Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 1 CORNERSTONE COUNSELING SERVICES, INC., 10 S MAIN STREET, #10, JEFFERSON, WI /01/014 0/9/016 CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 50, MILWAUKEE, WI CORNERSTONE COUNSELING SERVICES, INC., W PARK PLACE, #100, MILWAUKEE, WI 54 CORNERSTONE COUNSELING SERVICES, INC., 10 CORPORATE CENTER DRIVE, SUITE 100, OCON CORNERSTONE COUNSELING SERVICES, INC., 79 S 17TH AVENUE, #10, WEST BEND, WI 5095 CORNERSTONE COUNSELING SERVICES, INC., 400 BAY VIEW ROAD, SUITE C, MUKWONAGO, WI 51 CORNERSTONE COUNSELING SERVICES, INC., 4811 S 76TH STREET, GREENFIELD, WI 50 CORNERSTONE COUNSELING SERVICES, INC., 5555 N PORT WASHINGTON ROAD, #00, GLENDALE, CORNERSTONE COUNSELING SERVICES, INC., 741 N GRAND AVENUE, #0, WAUKESHA, WI 5186 CORNERSTONE COUNSELING SERVICES, INC., 888 THACKERAY TRAIL, #105, OCONOMOWOC, WI 5 01/01/015 0/9/016 0/01/014 0/9/016 09/9/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 09/9/014 ELMBROOK FAMILY COUNSELING CENTER 1690 W NORTH AVENUE BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 197 HOWARD J HAVEN, PHD Initial Cert: 0/01/1978 info@elmbrookfamilycounselingcent Phone: (6) /01/015 0/1/017 Fax: (6) /01/015 0/1/017 EULOPIA FAMILY SERVICES, INC. 15 DERRIN LANE BROOKFIELD, WI 5045 Waukesha County Surveyor: William Rohner Lic #: 570 MARICA TIPTON Initial Cert: 01/18/005 [email protected] Phone: (414) /01/014 01/1/016 Fax: (6) /01/014 01/1/016 PATHWAYS COUNSELING CENTER 1105 W. BLUEMOUND ROAD, #100 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 170 DAVID J. BEDRIN Initial Cert: 1/01/1985 [email protected] Phone: (6) /01/015 01/1/016 Fax: (6) /01/015 01/1/016 11/4/015 age 168 of 186

169 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH HOSPITAL II Lic #: W CAPITOL DR ND FLOOR BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner CAROL HESS Initial Cert: 07//005 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 1 WHEATON FRANCISCAN BEHAVIORAL HEALTH, 19 CAPITOL DRIVE, PEWAUKEE, WI /01/015 08/1/017 WISCONSIN EARLY AUTISM PROJECT, INC 150 N. SUNNYSLOPE RD SUITE 100 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 461 KIM SCHUTT-CHARDON Initial Cert: 05/0/00 [email protected] Phone: (608) /01/014 05/1/016 Fax: (608) /01/014 05/1/016 THE REDI CLINIC DELAFIELD 40 NORTH GENESSE ST #1 DELAFIELD, WI 5018 Waukesha County Surveyor: William Rohner Lic #: 007 THEODORE E. WELTZIN, MD Initial Cert: 09/0/01 [email protected] Phone: (6) /01/014 09/0/016 Fax: (6) MENTAL HEALTH-DAY TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 DOMINION BEHAVIORAL HEALTH SERVICES, LLC Lic #: 688 W1 N60 MARACH ROAD MENOMONEE FALLS, WI 5051 Waukesha County Surveyor: William Rohner FRANCINE DIXON Initial Cert: 11/01/006 [email protected] Phone: (6) /01/015 10/1/017 Fax: (6) /01/015 10/1/017 11/4/015 age 169 of 186

170 FROEDTERT & THE MEDICAL COLLEGE OF WI-COMMUNITY MEMORIAL HOSPITAL Lic #: 076 W180 N8085 TOWN HALL ROAD MENOMONEE FALLS, WI 5051 Waukesha County Surveyor: William Rohner LYNN DUNN Initial Cert: 10/01/198 Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 FROEDTERT PHYSICIANS PARTNERS W19 N 7055 NORTHFIELD DR, RD FLOOR, BLDG A MENOMONEE FALLS, WI 5051 Waukesha County Surveyor: William Rohner Lic #: 1579 JOANNE SZNAIDER Initial Cert: 0/01/1981 [email protected] Phone: (6) /01/015 09/0/017 Fax: (6) FROEDERT PHYSICIANS PARTNERS, 110 LONE OAK LANE, HARTFORD, WI 507 FROEDERT PHYSICIANS PARTNERS, W168 N117 WESTERN AVENUE, GERMANTOWN, WI 50 FROEDTERT COMMUNITY PHYSICIANS MOORLAND RESERVE, 4805 S. MOORLAND RD, NEW BERLIN, 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 NORRIS ADOLESCENT CENTER Lic #: 167 W47 S1095 CENTER DRIVE MUKWONAGO, WI 5149 Waukesha County Surveyor: William Rohner RON PUPP Initial Cert: 0/01/1995 [email protected] Phone: (6) /01/015 0/8/017 Fax: (6) /01/015 0/8/017 ROGERS MEMORIAL HOSPITAL 4700 VALLEY ROAD OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner Lic #: 1810 KATHY LOTZ Initial Cert: 08/01/1988 [email protected] Phone: (6) /01/015 10/1/017 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREAT/CHLDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 11/4/015 age 170 of 186

171 ROGERS MEMORIAL HOSPITAL - SILVER LAKE OUTPATIENT CENTER Lic #: CORPORATE CENTER DRIVE OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner KEITH MOREHOUSE Initial Cert: 09/8/015 [email protected] Phone: (6) /8/015 10/1/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREAT/CHILDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 09/8/015 10/1/016 SOUTH STREET CLINIC 169 E WISCONSIN AVE STE G OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner Lic #: 1841 ANNE A WESTON, PHD Initial Cert: 06/01/1984 [email protected] Phone: (6) /01/014 05/1/016 Fax: (6) /01/014 05/1/016 A HEALING CENTER/EFFICIENCY MANAGEMENT CONSULTING, S.C. Lic #: WATERTOWN ROAD WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner KAREN CRNKOVICH Initial Cert: 09/01/1987 [email protected] Phone: (6) /01/014 1/1/015 Fax: (6) /01/014 1/1/015 AURORA BEHAVIORAL HEALTH CENTER - WAUKESHA Lic #: 86 W1 N1440 HWY. CORPORATE CT #10 WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner KATE CONNELLY Initial Cert: 04/01/00 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-OUTPATIENT TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER - BROOKFIELD, WEST BLUEMOUND ROAD, BROOKFIE 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, W NATIONAL AVE, NEW BERLIN, WI 51 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-WAUKESHA, 6500 AURORA DRIVE, SUMMIT, WI /01/014 04/0/016 11/4/015 age 171 of 186

172 BETHANY CHRISTIAN SERVICES OF WI N14W755 STONE RIDGE DR #65 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 0 SUSAN HUBBELL Initial Cert: 06/01/014 [email protected] Phone: (6) /01/015 05/1/016 Fax: (6) /01/015 05/1/016 CATHOLIC CHARITIES - WAUKESHA 717 N. EAST AVENUE WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner Lic #: 114 MANDY BIBO Initial Cert: 06/01/1981 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 FAMILY SERVICE OF WAUKESHA 101 W BROADWAY, ND FLOOR WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner Lic #: 140 LAURA CHERONE Initial Cert: 09/01/1977 [email protected] Phone: (6) /01/014 01/1/016 Fax: (6) /01/014 01/1/016 FAMILY SERVICE OF WAUKESHA, 119A SILVER LAKE STREET, OCONOMOWOC, WI /01/014 06/07/014 FAMILY SERVICE OF WAUKESHA, 175 EAST WISCONSIN AVE STE H, OCONOMOWOC, WI /08/014 01/1/016 FAMILY SERVICE OF WAUKESHA, 76 N EAST AVENUE, WAUKESHA, WI /01/014 01/1/016 NATURE HILL INTERMEDIATE SCHOOL, 850 LAKE DRIVE, OCONOMOWOC, WI 5066 PRAIRIE ELEMENTARY SCHOOL, 1801 CENTER ROAD, WAUKESHA, WI 5186 SILVER LAKE INTERMEDIATE SCHOOL, 555 OCONOMOWOC PARKWAY, OCONOMOWOC, WI 5066 WHITTIER ELEMENTARY SCHOOL, 110 S. EAST AVENUE, WAUKESHA, WI /01/014 01/1/016 01/14/015 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 HORIZON HEALTHCARE, INC. 17 WISCONSIN AVE STE #11 WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner Lic #: 1058 EMILY HILL Initial Cert: 08/01/199 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 11/4/015 age 17 of 186

173 PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES Lic #: AMERICAN AVENUE #501 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner O. KIRK YAUCHLER Initial Cert: 06/01/1986 Phone: (6) /01/015 1/1/015 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS /01/015 1/1/015 01/01/015 1/1/015 1 PHCMA, INC. BEHAVIORAL HEALTH SVS - BIG BEND RD, 10 BIG BEND ROAD, WAUKESHA, WI /01/015 1/1/015 1 PHCMA, INC. BEHAVIORAL HEALTH SVS - DELAFIELD, 750 GOLF ROAD, DELAFIELD, WI /01/015 1/1/015 1 PROHEALTH CARE SLEEP CENTER, 01 SUN VALLEY DRIVE #00, DELAFIELD, WI /01/015 11/0/015 PHCMA, INC. BEHAVIORAL HEALTH SVS - BROOKFIELD, 085 NORTH CALHOUN RD, BROOKFIELD, WI PHCMA, INC. BEHAVIORAL HEALTH SVS - HARTLAND, 1500 WALNUT RIDGE DR, HARTLAND, WI 509 PHCMA, INC. BEHAVIORAL HEALTH SVS - MORELAND BLVD., 717 WEST MORELAND BLVD, WAUKESHA PHCMA, INC. BEHAVIORAL HEALTH SVS - MUKWONAGO, 40 WEST MAPLE AVE, MUKWONAGO, WI 5 PHCMA, INC. BEHAVIORAL HEALTH SVS - MUSKEGO, S69 W1566 JANESVILLE RD, MUSKEGO, WI 5 PHCMA, INC. BEHAVIORAL HEALTH SVS - NEW BERLIN, 1900 WEST NATIONAL AVE, NEW BERLIN, WI PHCMA, INC. BEHAVIORAL HEALTH SVS - OCONOMOWOC, 1185 CORPORATE CENTER DR SUITE 175 PHCMA, INC. BEHAVIORAL HEALTH SVS - PEWAUKEE, N16W411 RIVERWOOD DR., WAUKESHA, WI PHCMA, INC. BEHAVIORAL HEALTH SVS - SUSSEX, N57 W4950 N CORPORATE CIRCLE, SUSSEX, WI PHCMA, INC. BEHAVIORAL HEALTH SVS - WATERTOWN, 109 AIR PARK DR., WATERTOWN, WI 5094 WAUKESHA HEALTH SYS DBA PHCMA STONERIDGE, N14 W900 STONE RIDGE DR, PEWAUK 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 08/10/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 08/09/015 STRESS MANAGEMENT & MENTAL HEALTH CLINICS, INC. Lic #: N. GRANDVIEW BLVD., #0 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner PAUL GLASS Initial Cert: 10/01/1990 waukesha@stressmanagementclinic Phone: (6) /01/015 09/0/016 Fax: (6) /01/015 09/0/016 WAUKESHA COUNTY DHHS CCS 1501 AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 04 DANIELLE BIRDEAU Initial Cert: 07/01/014 [email protected] Phone: (6) /01/014 06/0/016 Fax: (6) CCS REGIONAL MODEL POPULATION-BASED DHS 6 07/01/014 06/0/016 1 WAUKESHA CO DHHS HUMAN SERVICES CENTER, 514 RIVERVIEW AVE, WAUKESHA, WI /01/014 06/0/016 11/4/015 age 17 of 186

174 WAUKESHA COUNTY HEALTH AND HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM Lic #: AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner BRAD HAAS Initial Cert: 10/01/1990 Phone: (6) /01/015 09/0/017 Fax: (6) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/015 09/0/017 WAUKESHA COUNTY MENTAL HEALTH CENTER 514 RIVERVIEW AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1970 GORDON OWLEY, PHD Initial Cert: 04/01/1984 [email protected] Phone: (6) /01/015 04/0/017 Fax: (6) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 WAUKESHA COUNTY MENTAL HEALTH CENTER, 1501 AIRPORT RD, WAUKESHA, WI /01/015 04/0/017 WAUKESHA COUNTY MENTAL HEALTH CENTER 1501 AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1971 JEFFRY LEWIS Initial Cert: 04/01/1987 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 WAUKESHA MEMORIAL HOSPITAL 75 AMERICAN AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1976 JULIE GINGRAS Initial Cert: 06/01/1986 [email protected] Phone: (6) /01/015 1/1/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 11/4/015 age 174 of 186

175 Waupaca County RAWHIDE YOUTH & FAMILY COUNSELING SERVICES Lic #: 750 E7475 RAWHIDE ROAD NEW LONDON, WI Waupaca County KELLY WISNEFSKE Initial Cert: 08//007 Phone: (877) /01/015 08/1/017 Fax: (90) /01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 0 N MAIN STREET, #01, WEST BEND, WI /01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 446 WESTHILL BLVD SUITE 6, APPLETON, WI /01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 5555 N PORT WASHINGTON RD STE 07, GLENDALE, W 09/01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 96 WILLARD DRIVE SUITE 8, GREEN BAY, WI /01/015 08/1/017 MINISTRY BEHAVIORAL HEALTH 190 GRAND SEASONS DRIVE WAUPACA, WI Waupaca County Lic #: 645 TERESA TAYLOR Initial Cert: 0/01/006 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT DHS /01/014 01/1/016 0/01/014 01/1/016 WAUPACA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP Lic #: HARDING STREET WAUPACA, WI Waupaca County CHUCK PRICE Initial Cert: 1/01/1981 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: HARDING STREET WAUPACA, WI Waupaca County CHUCK PRICE Initial Cert: 1/01/1981 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 WAUPACA CO DEPT OF HEALTH & HUMAN SERV, 1405 MILL ST, NEW LONDON, WI /01/014 06/0/016 11/4/015 age 175 of 186

176 NORTHWEST JOURNEY - WAUPACA 10 E MAIN STREET WEYAUWEGA, WI 5498 Waupaca County Lic #: 9 LAURA KOWALSKI Initial Cert: 08/05/010 [email protected] Phone: (90) /01/015 08/1/017 Fax: (90) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/017 09/01/015 08/1/017 11/4/015 age 176 of 186

177 Waushara County ALL AREA COUNSELING SERVICES-A DIVISION OF OPTIONS TREATMENT PROGRAMS INC Lic #: W MAIN STREET WAUTOMA, WI 5498 Waushara County KIMEKO HAGEN Initial Cert: 04/01/004 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 0/1/016 04/01/014 0/1/016 1 INTEGRATIVE PAIN MANAGEMENT SC, 555 S WASHBURN ST #A, OSHKOSH, WI /01/014 08/5/014 OPTIONS TREATMENT PROGRAMS, INC., 1000 N. LYNNDALE DRIVE STE C, APPLETON, WI OPTIONS TREATMENT PROGRAMS, INC., 44 S MONROE AVE #01, GREEN BAY, WI 5401 OPTIONS TREATMENT PROGRAMS, INC., 9 CHURCHILL ST, WAUPACA, WI OPTIONS TREATMENT PROGRAMS-OSHKOSH, 50 E. NEW YORK AVE., OSHKOSH, WI /01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: W. PARK STREET WAUTOMA, WI 5498 Waushara County TONI MORGAN JONES Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 BERLIN HIGH SCHOOL, MEMORIAL DRIVE, BERLIN, WI /01/014 10/1/016 TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI /01/014 10/1/016 WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI /01/014 10/1/016 WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI /01/014 10/1/016 WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI /01/014 10/1/016 WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: W. PARK STREET WAUTOMA, WI 5498 Waushara County RENEE SOROKO Initial Cert: 08/01/1997 [email protected]. Phone: (90) /01/014 10/1/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 age 177 of 186

178 WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: W PARK STREET WAUTOMA, WI 5498 Waushara County RENEE SOROKO Initial Cert: 10/19/005 [email protected]. Phone: (90) /01/014 10/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 11/01/014 10/1/016 11/4/015 age 178 of 186

179 Winnebago County PARTNERSHIP COMMUNITY HEALTH CENTER 1814 N APPLETON ROAD MENASHA, WI 5495 Winnebago County Lic #: 794 KRISTENE STACKER Initial Cert: 07/01/008 [email protected] Phone: (90) /01/015 06/0/017 Fax: (90) /01/015 06/0/017 1 EMERGENCY SHELTER OF THE FOX VALLEY, 400 N DIVISION STREET, APPLETON, WI /01/015 06/0/017 THE COUNSELING CLINIC-FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: APPLETON ROAD MENASHA, WI 5495 Winnebago County HOLLY KEYSER Initial Cert: 0/01/198 Phone: (90) /01/014 11/0/016 Fax: (90) /01/014 11/0/016 GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR, GREENVILLE, WI /01/014 09/09/015 HORTONVILLE HIGH SCHOOL, 11 E TOWNE DR., HORTONVILLE, WI /01/014 11/0/016 HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST., HORTONVILLE, WI /01/014 11/0/016 JR GERRITS MIDDLE SCHOOL, 545 SOUTH JOHN ST, KIMBERLY, WI /01/014 11/0/016 KAUKAUNA HIGH SCHOOL, 1701 COUNTY ROAD CE, KAUKAUNA, WI /01/014 11/0/016 KIMBERLY HIGH SCHOOL, 166 E KENNEDY AVE, KIMBERLY, WI /01/014 11/0/016 LITTLE CHUTE HIGH SCHOOL, 140 FREEDOM ROAD, LITTLE CHUTE, WI /01/014 11/0/016 NEENAH HIGH SCHOOL, 175 TULLAR RD, NEENAH, WI /01/014 11/0/016 SHATTUCK MIDDLE SCHOOL, 600 ELM STREET, NEENAH, WI /01/014 11/0/016 THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY Lic #: KENWOOD DRIVE SUITE 1 MENASHA, WI 5495 Winnebago County ROSANGELA BERBERT Initial Cert: 0/01/198 [email protected] Phone: (90) /01/015 0/8/017 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 1 PROJECT OPEN DOOR IMMANUEL UNITED CHURCH, 510 SULLIVAN AVENUE, KAUKAUNA, WI /01/015 0/8/017 1 THE SAMARITAN COUNSELING CENTER OF FV AT LHCC, 510 DOCTORS COURT, OSHKOSH, WI /19/016 0/8/017 1 THE SAMARITAN COUNSELING CTR FOX VALLEY, 1478 MIDWAY ROAD, MENASHA, WI /01/015 0/8/017 THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI /01/015 0/8/017 0/01/015 0/8/017 11/4/015 age 179 of 186

180 THEDACARE BEHAVIORAL HEALTH 1095 MIDWAY ROAD MENASHA, WI 5495 Winnebago County Lic #: 05 JEAN DEKEYSER, RN, MS Initial Cert: 07/1/1998 Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI /01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI THEDACARE BEHAVIORAL HEALTH, 1818 NORTH MEADE STREET, APPLETON, WI THEDACARE BEHAVIORAL HEALTH, 500 E CAPITAL DRIVE, APPLETON, WI THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI THEDACARE BEHAVIORAL HEALTH, 90 RIVERSIDE DRIVE, #04, WAUPACA, WI /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 REACH COUNSELING SERVICES 1509 S COMMERCIAL STREET NEENAH, WI Winnebago County Lic #: 180 LYN BEYER Initial Cert: 01/11/199 [email protected] Phone: (90) /01/015 1/1/016 Fax: (90) REACH COUNSELING SERVICES, INC., 414 DOCTORS COURT, SUITE 110, OSHKOSH, WI REACH COUNSELING SVS,INC-LOCATED INSIDE BABES, INC, 11 E. WISCONSIN AVENUE, APPLETO 01/01/015 1/1/016 01/01/015 1/1/016 11//015 1/1/016 THEDACARE BEHAVIORAL HEALTH AT THEDA CLARK MEDICAL CENTER Lic #: SECOND STREET NEENAH, WI Winnebago County COLLETTE HARTFIEL Initial Cert: 0/01/198 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 01/1/017 0/01/015 01/1/017 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: N COMMERCIAL STREET NEENAH, WI Winnebago County MICHAEL DAEHN PHD Initial Cert: 07/01/1988 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 11/4/015 age 180 of 186

181 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: N. COMMERCIAL STREET NEENAH, WI Winnebago County KATHLEEN RASMUSSEN Initial Cert: 11/01/000 Phone: (90) /01/014 10/1/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 AURORA MEDICAL GROUP OSHKOSH 700 N WESTHAVEN DRIVE OSHKOSH, WI Winnebago County Lic #: 540 KATE SIEBERS Initial Cert: 09/01/004 [email protected] Phone: (90) /01/015 08/1/017 Fax: (90) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/017 09/01/015 08/1/017 1 AURORA MEDICAL GROUP MARINETTE, 10 SHORE DRIVE, MARINETTE, WI /01/015 08/1/017 1 AURORA MEDICAL GROUP OSHKOSH, 414 DOCTORS COURT, OSHKOSH, WI /01/015 08/1/017 1 AURORA MEDICAL GROUP OSHKOSH, 855 N WESTHAVEN DR, OSHKOSH, WI /01/015 08/1/017 AURORA MEDICAL GROUP OSHKOSH, 116 WESTOWNE DR, NEENAH, WI AURORA MEDICAL GROUP OSHKOSH, 14 W FOND DU LAC STREET, RIPON, WI AURORA MEDICAL GROUP OSHKOSH, 10 WISCONSIN AMERICAN DRIVE, FOND DU LAC, WI /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 MERCY COUNSELING SERVICES 500 SOUTH OAKWOOD RD OSHKOSH, WI Winnebago County Lic #: 161 TINA LECHNIR Initial Cert: 0/01/1995 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 MERCY MEDICAL CENTER 500 S OAKWOOD ROAD OSHKOSH, WI Winnebago County Lic #: 1608 TINA LECHNIR Initial Cert: 0/01/198 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) -404 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 11/4/015 age 181 of 186

182 OSHKOSH COUNSELING CENTER, INC. 501 MERRITT AVENUE OSHKOSH, WI Winnebago County Lic #: 17 RACHELLE LAUX Initial Cert: 09/01/1985 Phone: (90) /01/014 11/0/016 Fax: (90) /01/014 11/0/016 SHERMAN CONSULTING OSHKOSH 70 STATE ROAD 44, #D OSHKOSH, WI Winnebago County Lic #: 58 HANK SHERMAN, PHD Initial Cert: 0/0/005 Phone: (90) /01/014 0/1/016 Fax: (90) /01/014 0/1/016 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: 66 0 WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MELISSA HOODIE Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 age 18 of 186

183 WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN PHD Initial Cert: 0/09/005 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 WINNEBAGO MENTAL HEALTH INSTITUTE TREFFERT DRIVE & BUTLER AVENUE WINNEBAGO, WI Winnebago County Lic #: 008 THOMAS SPEECH Initial Cert: 10/01/1975 Phone: (90) /01/015 10/1/017 Fax: (90) 7-04 CSAS-MEDICALLY MONITORED TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 10/1/017 11/01/015 10/1/017 11/01/015 10/1/017 Winona County (MN) HIAWATHA VALLEY MENTAL HEALTH CENTER 166 MAIN STREET WINONA, MN Winona County (MN) Surveyor: Roderic Senn Lic #: 8 JULIE HANSON Initial Cert: 09/1/009 [email protected] Phone: (507) /01/014 08/1/016 Fax: (507) CSAS-OUTPATIENT TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 1 4TH ST. S, LA CROSSE, WI /16/015 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 19 MAIN STREET, LA CROSSE, WI /01/014 10/15/015 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 611 BROADWAY AVENUE, #100, WABASHA, MN /01/014 08/1/016 HIAWATHA VALLEY MENTAL HEALTH CENTER, 85 S. SERVICE DR., STE. 10, RED WING, MN HIAWATHA VALLEY MENTAL HEALTH CENTER, LA CROSSE CNTY JUVE FAC TH ST NORTH, LA C 06/05/015 08/1/016 09/01/014 08/1/016 11/4/015 age 18 of 186

184 Wood County MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: SOUTH CHERRY AVE, #5 MARSHFIELD, WI Wood County THOMAS JOHNSTON, PHD Initial Cert: 01/01/006 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 01/01/015 1/1/016 01/01/015 1/1/016 MFHS - LINCOLN HIGH SCHOOL, TH STREET SOUTH, WISCONSIN RAPIDS, WI /01/015 1/1/016 MFHS - MARSHFIELD MIDDLE SCHOOL, 900 EAST 4TH STREET, MARSHFIELD, WI /01/015 1/1/016 MFHS - PITTSVILLE ELEMENTARY SCHOOL, 5459 ELEMENTARY AVENUE, STE #1, PITTSVILLE, WI /0/016 1/1/016 MFHS PITTSVILLE HIGH SCHOOL, ST AVENUE, PITTSVILLE, WI /01/015 1/1/016 MHFS - EAST JUNIOR HIGH SCHOOL, 11 LINCOLN STREET, WISCONSIN RAPIDS, WI /0/016 1/1/016 MARSHFIELD CLINIC DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL HEALTH Lic #: N OAK AVENUE MARSHFIELD, WI Wood County SANDRA BUMP Initial Cert: 1/01/198 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/014 11/0/016 1/01/014 11/0/016 1 MARSHFIELD CLINIC MOSINEE CENTER, 90 ORBITING DRIVE, MOSINEE, WI /01/014 11/0/015 1 MARSHFIELD CLINIC WAUSAU CENTER, 77 PLAZA DRIVE, WAUSAU, WI /01/014 11/0/016 NORWOOD HEALTH CENTER 1600 N. CHESTNUT AVENUE MARSHFIELD, WI Wood County Lic #: 1709 RHONDA KOZIK Initial Cert: 04/01/1980 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 01/1/017 0/01/015 01/1/017 WISE MIND MENTAL HEALTH CLINIC, LLC 601 EAST RD ST MARSHFIELD, WI Wood County Lic #: 019 PATRICIA K FABER Initial Cert: 0/1/014 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) /01/015 0/1/017 11/4/015 age 184 of 186

185 CENTRAL WISCONSIN COUNSELING ASSOCIATES Lic #: 9 0 W. GRAND AVE SUITE 04A WISCONSIN RAPIDS, WI Wood County AMY GUNDERSON Initial Cert: 01/01/001 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) /01/014 1/1/015 1 CENTRAL WISCONSIN COUNSELING ASSOCIATES, 116 STRONGS AVE, STEVENS POINT, WI /01/014 09/06/015 1 CENTRAL WISCONSIN COUNSELING ASSOCIATES, INC, 801 ND STREET, PORT EDWARDS, WI /01/014 1/1/015 1 CENTRAL WISONSIN COUNSELING ASSOCIATES, 95 POST ROAD, STEVENS POINT, WI /07/015 1/1/015 LINCOLN HIGH SCHOOL, TH STREET SOUTH, WISCONSIN RAPIDS, WI RIVER CITIES HIGH SCHOOL, 90-48TH STREET SOUTH, WISCONSIN RAPIDS, WI /01/014 1/1/015 01/01/014 1/1/015 CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC Lic #: TH ST SOUTH STE #101 WISCONSIN RAPIDS, WI Wood County DEB FUEHRER Initial Cert: 09/7/01 [email protected] Phone: (715) /01/015 08/1/016 Fax: (888) CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 CHILD & ADOLESCENT PSYCHIATRY CONSULTING, M407 STATE HWY 97, MARSHFIELD, WI /01/015 08/1/016 HUMKE ELEMENTARY, 500 S. SECTION STREET, NEKOOSA, WI WASHINGTON ELEMENTARY, 911 WASHINGTON STREET, WISCONSIN RAPIDS, WI WISCONISN RAPIDS AREA MIDDLE SCHOOL, 191 7TH AVENUE SOUTH, WISCONSIN RAPIDS, WI 54 10/8/016 08/1/016 10/8/016 08/1/016 10/8/016 08/1/016 CLINICAL SERVICES 40-1ST AVENUE SOUTH WISCONSIN RAPIDS, WI Wood County Lic #: 108 DR MICHAEL J NELSON Initial Cert: 10/01/1988 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-INTERVENTION DHS /01/015 09/0/017 10/01/015 09/0/016 NORTHWEST JOURNEY - WISCONSIN RAPIDS 110-4TH STREET SOUTH WISCONSIN RAPIDS, WI Wood County Lic #: 91 LAURA DUCKETT Initial Cert: 0/1/001 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH-DAY TREAT/CHILDREN 1 W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 04/01/015 0/1/017 04/01/015 0/1/017 11/4/015 age 185 of 186

186 WOOD COUNTY HUMAN SERVICES CCS 611-1TH AVENUE, SOUTH WISCONSIN RAPIDS, WI Wood County Lic #: 678 KATHY ROETTER Initial Cert: 08/01/1977 Phone: (715) /01/014 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 09/01/014 06/0/016 07/01/014 08/1/014 WOOD COUNTY HUMAN SERVICES DEPARTMENT Lic #: TH STREET SOUTH WISCONSIN RAPIDS, WI Wood County SUSAN SCHUELER-SHEVELAND Initial Cert: 08/01/1977 Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORWOOD HEALTH CARE BRANCH OFFICE, 1600 NORTH CHESTNUT, MARSHFIELD, WI /01/014 06/0/016 11/4/015 age 186 of 186