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

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 5701-969 ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: 810 108 E NORTH STREET FRIENDSHIP, WI 594 Adams County DIANE CABLE Initial Cert: 1/10/008 diane.cable@co.adams.wi.us Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) 9-4585 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Lic #: 15 108 E NORTH STREET FRIENDSHIP, WI 594 Adams County DIANE CABLE Initial Cert: 09/01/1990 diane.cable@co.adams.wi.us Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) 9-4585 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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

Ashland County ASHLAND COUNTY HEALTH AND HUMAN SERVICES/NORTHLAND COUNSELING SERVICES Lic #: 69 1619 WEST THIRD STREET ASHLAND, WI 54806 Ashland County Surveyor: Polly Wong TERRI PERRY Initial Cert: 01/6/006 terri@hsd.co.ashland.wi.us Phone: (715) 68-7004 04/01/015 0/1/017 Fax: (715) 68-794 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 #: 154 165 MAPLE LANE ASHLAND, WI 54806 Ashland County Surveyor: Polly Wong CONNIE GUDERIAN Initial Cert: 10/01/1999 cguderian@ashlandmmc.com Phone: (715) 685-5400 10/01/015 09/0/017 Fax: (715) 685-510 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI 54806 10/01/015 09/0/017 DRUMMOND AREA SCHOOL DISTRICT, 5440 EASTERN AVE, DRUMMOND, WI 548 10/01/015 09/0/017 NORTHLAND COLLEGE, 1411 ELLIS AVE, ASHLAND, WI 54806 11/05/016 09/0/017 NEW HORIZONS NORTH CCS - ASHLAND COUNTY Lic #: 055 514 WEST MAIN STREET ASHLAND, WI 54806 Ashland County VALERIE LEVNO Vlevno@nhnorth.com Phone: (715) 68-7171 Fax: Initial Cert: 01/01/015 NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM Lic #: 1664 514 W MAIN STREET ASHLAND, WI 54806 Ashland County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 05/1/1991 VLevno@nhnorth.com Phone: (715) 68-7171 1/01/015 11/0/017 Fax: (715) 68-7176 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page of 186

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 david.hensley@co.barron.wi.us Phone: (715) 57-5691 11/01/015 10/1/017 Fax: (715) 57-6848 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 #: 95 11 E. EAU CLAIRE STREET RICE LAKE, WI 54868 Barron County Surveyor: Polly Wong DAVID HENSLEY Initial Cert: 11/01/010 david.hensley@co.barron.wi.us Phone: (715) 57-5691 11/01/015 10/1/017 Fax: (715) 57-6848 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 MARRIAGE AND FAMILY HEALTH SERVICES, LTD Lic #: 707 105 WEST AVENUE RICE LAKE, WI 54868 Barron County Surveyor: Polly Wong DR. TOM JOHNSTON Initial Cert: 0/01/007 tomjohnstons@sbcglobal.net Phone: (715) 8-08 0/01/014 01/1/016 Fax: (715) 8-0771 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 0/01/014 01/1/016 11/4/015 Page of 186

Bayfield County NORTHLAKES COMMUNITY CLINIC - AODA SERVICES Lic #: 1064 7665 US HWY IRON RIVER, WI 54847 Bayfield County Surveyor: Polly Wong JASON AKL Initial Cert: 09/01/1984 jakl@northlakesclinic.org Phone: (715) 7-5001 10/01/014 08/1/016 Fax: (715) 7-5067 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/014 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 54891 10/01/015 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 54806 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI 54806 BAD RIVER HEAD START, 5759 PINE STREET, ODANAH, WI 54861 LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI 54806 10/01/015 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 #: 054 4 WEST BAYFIELD STREET WASHBURN, WI 54891 Bayfield County Surveyor: Polly Wong VAL LEVNO Initial Cert: 01/01/015 vlevno@nhnorth.com Phone: (715) 7-6144 01/01/015 1/1/015 Fax: (715) 7-610 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 54891 Bayfield County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 07/01/014 vlevno@nhnorth.com Phone: (715) 7-5505 07/01/015 06/0/017 Fax: (715) 7-0 1 CALM WATERS WELLNESS, NORTH FIRST ST, BAYFIELD, WI 54814 1 NEW HORIZONS NORTH DBA CALM WATERS WELLNESS, 1001 W MAIN STREET, ASHLAND, WI 54806 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI 54806 ASHLAND MIDDLE SCHOOL, 0 11TH STREET EAST, ASHLAND, WI 54806 BAYFIELD ELM/MIDDLE & HIGH SCHOOL, 00 NORTH 4TH STREET, BAYFIELD, WI 54814 LAKE SUPERIOR PRIMARY & INTERMEDIATE SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI 54806 RED CLIFF EARLY CHILDHOOD CENTER, 8980 TINY TOT DRIVE, BAYFIELD, WI 54814 WASHBURN ELM/MIDDLE SCHOOL, 411 WEST 8TH STREET, WASHBURN, WI 54891 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 09/01/015 07/01/015 06/0/017 11/4/015 Page 4 of 186

NEW HORIZONS NORTH-COMMUNITY SUPPORT PROGRAM Lic #: 166 4 W BAYFIELD STREET WASHBURN, WI 54891 Bayfield County Surveyor: Polly Wong VALERIE LEVNO Initial Cert: 0/01/1991 vlevno@nhnorth.com Phone: (715) 7-5505 1/01/015 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 54891 Bayfield County Surveyor: Polly Wong Lic #: 61 JEREMY KOEHL Initial Cert: 07/01/001 northland006@centurytel.net Phone: (715) 7-0160 07/01/014 06/0/016 Fax: (715) 7-016 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI 54891 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI 54806 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI 5451 07/01/014 06/0/016 11/4/015 Page 5 of 186

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 kccarmody@spectrumbh.com Phone: (90) 784-644 01/0/015 01/1/016 Fax: (90) 784-655 01/0/015 01/1/016 AURORA BEHAVIORAL HEALTH CENTER 1881 CHICAGO STREET DE PERE, WI 54115 Brown County Lic #: 76 MELISA VANDE HEI Initial Cert: 06/08/007 melisa.vande.hei@aurora.org Phone: (90) 40-8061 07/01/014 06/0/016 Fax: (90) 40-809 07/01/014 06/0/016 EMPLOYEE RESOURCE CENTER, INC. 1511 WEST MAIN AVE SUITE 100 DE PERE, WI 54115 Brown County Lic #: 101 JAMES PECARD III Initial Cert: 07/01/1989 jpecard@assisterc.com Phone: (90) 40-7600 08/01/014 07/1/016 Fax: (90) 40-760 08/01/014 07/1/016 LIVING HOPE CHRISTIAN COUNSELING 066 LAWRENCE DRIVE DE PERE, WI 54115 Brown County Lic #: 597 JOHN C JOHNSON Initial Cert: 08/1/005 jcjohnson@livinghopellc.org Phone: (90) 8-8699 09/01/014 08/1/016 Fax: (90) 6-181 09/01/014 08/1/016 NORTHWEST JOURNEY - GREEN BAY 00 S SIXTH ST, LOWER LEVEL DE PERE, WI 54115 Brown County Lic #: 160 JENNIFER SOVEY-FAHEY Initial Cert: 11/01/1999 nwjgreenbay@nwcgc.com Phone: (90) 6-8960 11/01/015 10/1/017 Fax: (90) 6-896 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

RIVERSIDE PSYCHIATRIC GROUP SC 15 ANGELS PATH DE PERE, WI 54115 Brown County Lic #: 64 DINA BRAUN Initial Cert: 1/01/000 Dinab@riversidepsych.com Phone: (90) 8-855 01/01/015 1/1/016 Fax: (90) 8-970 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 1/1/016 01/01/015 1/1/016 WISCONSIN EARLY AUTISM PROJECT, INC. 1141 W. MAIN AVE #01 DE PERE, WI 54115 Brown County Lic #: 460 KIM SCHUTT-CHARDON Initial Cert: 04/01/00 kim.schutt-chardon@wiautism.com Phone: (608) 66-97 04/01/015 0/1/016 Fax: (608) 66-9041 04/01/015 0/1/016 AMERICAN FOUNDATION OF COUNSELING SERVICES, INC. Lic #: 105 10 E WALNUT STREET #706 GREEN BAY, WI 5401 Brown County JILL BECK Initial Cert: 04/01/1981 jbeck@afcscounseling.org Phone: (90) 47-856 05/01/014 04/0/016 Fax: (90) 47-1188 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/014 04/0/016 05/01/014 04/0/016 1 GOLDEN HOUSE, 110 UNIVERSITY AVE, GREEN BAY, WI 540 05/01/014 04/0/016 1 HOUSE OF HOPE, 1660 CHRISTIANA ST., GREEN BAY, WI 540 05/01/014 04/0/016 1 MICAH CENTER, 700 E. WALNUT ST., GREEN BAY, WI 5401 01/01/015 04/0/016 1 NEW COMMUNITY CLINIC - NWTC, 740 W. MASON ST., GREEN BAY, WI 5407 01/1/015 04/0/016 1 NEW COMMUNITY CLINIC, 6 BODART ST, GREEN BAY, WI 5401 01/1/015 04/0/016 1 OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI 540 01/01/015 04/0/016 NEW COMMUNITY SHELTER, 01 MATHER ST, GREEN BAY, WI 5401 01/01/015 04/0/016 BAETEN COUNSELING & CONSULTATION TEAM, S.C Lic #: 047 90 S WEBSTER AVE, SUITE B GREEN BAY, WI 5401 Brown County TINA BAETEN Initial Cert: 08/06/014 tina@baetencounseling.com Phone: (90) 6-4471 08/01/015 07/1/017 Fax: (90) 6-415 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 07/1/017 08/01/015 07/1/017 11/4/015 Page 7 of 186

BELLIN PSYCHIATRIC CENTE BELLEVUE 6 EATON ROAD GREEN BAY, WI 5411 Brown County Lic #: 44 STEVE DUSCHER Initial Cert: 10/10/00 sldusc@bellin.org Phone: (90) 41-5687 11/01/014 10/1/016 Fax: (90) 41-0 11/01/014 10/1/016 BELLIN PSYCHIATRIC CENTER-MANITOWOC, 415 CUSTER ST SUITE D, MANITOWOC, WI 540 11/01/014 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 sldusc@bellin.org Phone: (90) 41-5687 04/01/014 0/1/016 Fax: (90) 41-0 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 04/01/014 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 5401 08/04/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - BRILLION, 964 W. RYAN ST., STE. B, BRILLION, WI 54110 04/0/015 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 575-4TH ST, KEWAUNEE, WI 5416 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 704 S. WEBSTER STE. #01, GREEN BAY, WI 5401 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI 5401 04/01/014 0/1/016 BELLIN PSYCHIATRIC CENTER - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI 54115 BELLIN PSYCHIATRIC CENTER - OCONTO FALLS, 8 MAIN STREET, OCONTOFALLS, WI 54154 BELLIN PSYCHIATRIC CENTER-NEURO TEAM, 75 S WEBSTER, GREEN BAY, WI 5405 BELLIN PSYCHIATRIC CENTER-W. DE PERE, 1800 LAWRENCE DR, DE PERE, WI 54115 DR. ROSA MINOKA-HILL SCHOOL, 5 N ROOSEVELT, GREEN BAY, WI 5401 1/0/014 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 #: 41 160 COMMANCHE AVENUE GREEN BAY, WI 541 Brown County STEVE DUSCHER Initial Cert: 06/0/000 sldusc@bellin.org Phone: (90) 40-4780 07/01/014 06/0/016 Fax: (90) 40-4787 07/01/014 06/0/016 1 BELLIN PSYCHIATRIC CENTER-ONCOLOGY, 1580 COMMANCHE AVENUE, GREEN BAY, WI 541 07/01/014 06/0/016 1 BELLIN PSYCHIATRIC CENTER-UNITED HEALTHCARE, 100 AMS BLVD, GREEN BAY, WI 541 07/01/014 06/0/016 11/4/015 Page 8 of 186

BROWN COUNTY COMMUNITY TREATMENT CENTER Lic #: 1117 150 GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 10/01/1975 agar_ij@co.brown.wi.us Phone: (90) 91-6959 09/01/015 08/1/017 Fax: (90) 91-4811 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 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 61.71 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 09/01/015 08/1/017 BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI 5405 09/01/015 08/1/017 BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: 615 150 GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 08/5/005 Agar_IJ@co.brown.wi.us Phone: (90) 91-6959 09/01/014 08/1/016 Fax: (90) 91-4811 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 #: 81 150 GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 06/4/00 Agar_IJ@co.brown.wi.us Phone: (90) 91-6959 09/01/015 08/1/017 Fax: (90) 91-4811 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 #: 1140 185 RIVERSIDE DRIVE GREEN BAY, WI 5405 Brown County CELIA J. LATOUR Initial Cert: 01/01/1988 clatour@gbdioc.org Phone: (90) 7-84 0/01/015 01/1/017 Fax: (90) 47-4067 0/01/015 01/1/017 CATHOLIC CHARITIES OF GREEN BAY, 844 PIERCE AVENUE, SUITE 00, MARINETTE, WI 5414 0/01/015 01/1/017 11/4/015 Page 9 of 186

FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: 19 00 CROOKS STREET GREEN BAY, WI 5401 Brown County LOIS MISCHLER Initial Cert: 01/1/1996 lmischler@familyservicesnew.org Phone: (90) 46-6800 04/01/014 0/1/016 Fax: (90) 4-5966 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 1 BILLIE KRESS CENTER - YOUTH DEVELOPMENT, 40 SPIRIT WAY, GREEN BAY, WI 5404 04/01/014 0/1/016 1 FAMILY SERVICES - SOUTH IRWIN, 66 S IRWIN AVENUE, GREEN BAY, WI 5401 04/0/014 0/1/016 1 WILLOW TREE, 50 S MONROE STREET, GREEN BAY, WI 5401 04/0/014 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 jgreenwell@familyserviesnew.org Phone: (90) 4-7 04/01/015 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 #: 1 145 W MASON STREET, #01 GREEN BAY, WI 540 Brown County KENNETH SANN Initial Cert: 06//001 Ks.iacs@tds.net Phone: (90) 48-8141 07/01/014 06/0/016 Fax: (90) 48-799 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 INNOVATIVE COUNSELING, INC. 1499 SIXTH STREET GREEN BAY, WI 5404 Brown County Lic #: 8 CINDY HALFORD Initial Cert: 1/14/000 cindyhalford@innovativecounseling. Phone: (90) 497-6161 01/01/015 1/1/016 Fax: (90) 498-0476 01/01/015 1/1/016 1 INNOVATIVE COUNSELING, INC., 7488 SPRUCE STREET, MINOCQUA, WI 54548 10/0/016 1/1/016 11/4/015 Page 10 of 186

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 mkriesch@oneidanation.org Phone: (90) 490-790 0/01/015 01/1/017 Fax: (90) 490-88 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 01/1/017 0/01/015 01/1/017 1 ONEIDA COMMUNITY HEALTH CENTER, 55 AIRPORT DRIVE, ONEIDA, WI 54155 0/01/015 01/1/017 1 ONEIDA NATION VETERAN'S DEPARTMENT, 14 RIVERDALE DR., ONEIDA, WI 54155 0/01/015 01/1/017 ONEIDA NATION ELEMENTARY SCHOOL, N715 SEMINARY ROAD, ONEIDA, WI 54155 ONEIDA NATION HIGH SCHOOL, N710 SEMINARY ROAD, ONEIDA, WI 54155 0/01/015 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 welkandassociates@yahoo.com Phone: (90) 461-580 04/01/015 0/1/016 Fax: (888) 449-64 04/01/015 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 pattynewwellnessassoc@gmail.com Phone: (90) 497-600 06/01/014 05/1/016 Fax: (90) 497-15 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/014 05/1/016 06/01/014 05/1/016 1 NEW WELLNESS ASSOCIATES INC, 40 CROOKS AVENUE, KAUKAUNA, WI 5410 06/01/014 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 powerforchangellc@gmail.com Phone: (90) 965-7707 11/01/015 10/1/017 Fax: (888) 496-67 11/01/015 10/1/017 11/4/015 Page 11 of 186

ST. VINCENT HOSPITAL DBA PREVEA HEALTH 680 VERNON DRIVE GREEN BAY, WI 5404 Brown County Lic #: 174 JEFFREY STUMBRAS Initial Cert: 1/09/1996 Jeff.Stumbras@prevea.com Phone: (90) 7-100 0/01/014 1/1/015 Fax: (90) 7-101 0/01/014 1/1/015 1 LENA PRIMARY CARE CLINIC, 00 S ROSERA STREET, LENA, WI 5419 0/01/014 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 5401 0/01/014 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 5411 0/01/014 1/1/015 1 PREVEA EAST DEPERE HEALTH CENTER, 860 MONROE ROAD, DE PERE, WI 54115 0/01/014 1/1/015 1 PREVEA OCONTO FALLS, 85 MAIN STREET, OCONTO FALLS, WI 54154 1/04/014 1/1/015 1 PREVEA OCONTO HEALTH CENTER, 60 SMITH STREET, OCONTO, WI 5415 0/01/014 1/1/015 1 PREVEA PULASKI HEALTH CENTER, 940 S AUGUSTINE STREET, PULASKI, WI 5416 0/01/014 1/1/015 VILLA HOPE COMMUNITY SUPPORT PROGRAM OF BROWN COUNTY Lic #: 1965 1100 GUNS ROAD GREEN BAY, WI 5411 Brown County MOLLIE TOONEN Initial Cert: 0/06/1996 mtoonen@villahopecsp.com Phone: (90) 469-700 0/01/014 0/9/016 Fax: (90) 469-5599 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 54610 Buffalo County Surveyor: Roderic Senn Lic #: 887 DONNA JULEFF Initial Cert: 11/4/009 juleffd@nelson-tel.net Phone: (715) 495-896 11/01/015 10/1/016 Fax: (715) 85-597 1 CATALYST FOR CHANGE CONSULTANTS, 18484 BLAIR STREET, WHITEHALL, WI 5477 11/01/015 10/1/016 11/01/015 10/1/016 11/4/015 Page 1 of 186

Burnett County ACCESS INC COMMUNITY SUPPORT PROGRAM Lic #: 6 448 STATE ROAD 70/5 UNIT D SIREN, WI 5487 Burnett County Surveyor: Polly Wong ANDREW WOLF Initial Cert: 01/01/006 awolf@auroraservices.com Phone: (715) 49-7 01/01/015 1/1/016 Fax: (715) 49-705 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 #: 60 7410 COUNTY K, #80 SIREN, WI 5487 Burnett County Surveyor: Polly Wong BYRON HOPKE Initial Cert: 1/01/005 bhopke@burnettcounty.org Phone: (715) 49-7600 1/01/014 11/0/016 Fax: (715) 49-140 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 ffcc@familiesfirst.ws Phone: (715) 49-891 0/01/015 01/1/017 Fax: (715) 49-8981 0/01/015 01/1/017 1 FAMILIES FIRST COUNSELING CENTER, LLC, 809 US HWY 8, ST CROIX FALLS, WI 5404 0/01/015 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 nwjsiren@nwcgc.com Phone: (715) 49-89 04/01/014 0/1/016 Fax: (715) 49-77 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

ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC Lic #: 17 4404 STATE RD 70 WEBSTER, WI 5489 Burnett County Surveyor: Polly Wong SARAH CORMELL Initial Cert: 05/01/000 sarahc@stcroixtribalcenter.com Phone: (715) 49-8554 05/01/014 04/0/016 Fax: (715) 49-858 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/014 04/0/016 05/01/014 04/0/016 1 ROUND LAKE CLINIC, 0-60TH AVENUE, LUCK, WI 5485 05/01/014 04/0/016 Calumet County CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 110 06 COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 10/01/1975 Kral.Jeremy@co.calumet.wi.us Phone: (90) 849-1400 07/01/014 06/0/016 Fax: (90) 849-1468 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54915 07/01/014 06/0/016 CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: 44 06 COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 07/01/000 Kral.Jeremy@co.calumet.wi.us Phone: (90) 849-1400 07/01/014 06/0/016 Fax: (90) 849-1468 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 #: 674 06 COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 06/1/006 Kral.Jeremy@co.calumet.wi.us Phone: (90) 849-1400 07/01/015 06/0/017 Fax: (90) 849-1468 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

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 mfhsec@sbcglobal.net Phone: (715) 76-908 05/01/014 04/0/016 Fax: (715) 76-871 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 #: 1475 661 COUNTY HIGHWAY I CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn THERESA MACKEY Initial Cert: 01/1/1977 theresa.mackey@hshs.org Phone: (715) 7-5585 0/01/014 01/1/016 Fax: (715) 717-7504 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 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 #: 066 711 N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 05/01/015 jchaffee@co.chippewa.wi.us Phone: (715) 76-7788 05/01/015 04/0/016 Fax: (715) 76-776 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 54610 05/01/015 04/0/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI 5476 05/01/015 04/0/016 WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM - CSP Lic #: 064 711 N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 05/01/015 jchaffee@co.chippewa.wi.us Phone: (715) 78-585 05/01/015 04/0/016 Fax: (715) 76-776 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 54610 05/01/015 04/0/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI 5476 05/01/015 04/0/016 11/4/015 Page 15 of 186

WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS Lic #: 065 711 N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 04/01/015 jchaffee@co.chippewa.wi.us Phone: (715) 76-7788 04/01/015 0/1/016 Fax: (715) 76-776 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 54610 04/01/015 0/1/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI 5476 04/01/015 0/1/016 1 RUSK COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 11 E. MINER STREET, LADYSMITH, WI 54848 04/01/015 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 54751 DUNN COUNTY DEPT OF HUMAN SERVICES, 808 MAIN STREET, MENOMONIE, WI 54751 PIERCE COUNTY DEPT OF HUMAN SERVICES, 41 W. KINNE STREET, ELLSWORTH, WI 54011 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

Clark County CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET RM 50 NEILLSVILLE, WI 54456 Clark County Surveyor: Roderic Senn Lic #: 101 SUE VOIGT Initial Cert: 01/01/1984 sue.voigt@co.clark.wi.us Phone: (715) 74-508 01/01/014 1/1/015 Fax: (715) 74-509 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 54460 01/01/014 1/1/015 GRANTON SCHOOL DISTRICT, 17 N. MAIN STREET, GRANTON, WI 5446 LOYAL SCHOOL DISTRICT, 514 WEST CENTRAL STREET, LOYAL, WI 54446 NEILLSVILLE ELEMENTARY SCHOOL, 405 EAST 5TH STREET, NEILLSVILLE, WI 54456 NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456 08/10/015 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 54456 Clark County Surveyor: Roderic Senn Lic #: 09 SUE VOIGT Initial Cert: 09/01/015 sue.voigt@co.clark.wi.us Phone: (715) 74-508 09/01/015 08/1/016 Fax: (715) 74-509 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 #: 10 517 COURT ST, ROOM 50 NEILLSVILLE, WI 54456 Clark County Surveyor: Roderic Senn RUSSELL GIRARD Initial Cert: 04/01/1991 russell.girard@co.clark.wi.us Phone: (715) 74-508 1/01/01 11/0/015 Fax: (715) 74-509 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

Columbia County ASPEN FAMILY COUNSELING 69 NEW PINERY ROAD, #1 PORTAGE, WI 5901 Columbia County Lic #: 1066 BARRY ERATH Initial Cert: 01/01/015 berath@aspenfc.com Phone: (608) 74-500 01/01/015 1/1/015 Fax: (608) 74-641 01/01/015 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 5954 10/9/015 1/1/015 COLUMBIA COUNTY COMMUNITY SUPPORT PROGRAM Lic #: 11 901 HUNTERS TRAIL PORTAGE, WI 5901 Columbia County PAMELA J POLZER Initial Cert: 1/01/1997 PPolzer@pauquette.com Phone: (608) 74-544 1/01/015 11/0/017 Fax: (608) 74-4087 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: 898 65 MURPHY ROAD PORTAGE, WI 5901 Columbia County DAWN WOODARD Initial Cert: 04/01/010 dawn.woodard@co.columbia.wi.us Phone: (608) 74-9717 04/01/015 0/1/017 Fax: (608) 74-9700 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 COLUMBIA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: 670 65 MURPHY ROAD PORTAGE, WI 5901 Columbia County DAWN WOODARD Initial Cert: 07/01/006 dhhs@co.columbia.wi.us Phone: (608) 74-97 11/01/015 10/1/017 Fax: (608) 74-9700 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 11/4/015 Page 18 of 186

COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS Lic #: 149 901 HUNTERS TRAIL PORTAGE, WI 5901 Columbia County DR. JOCELYN MILLER PHD Initial Cert: 10/08/1999 jmiller@pauquette.com Phone: (608) 74-5518 07/01/015 06/0/016 Fax: (608) 74-4087 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/015 06/0/016 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 100 LINCOLN AVE, BARABOO, WI 591 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 19 PARK AVENUE, COLUMBUS, WI 595 07/01/015 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 5578 07/01/015 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 sarahkravick@compasscounseling.i Phone: (608) 745-4900 05/01/015 04/0/017 Fax: (608) 745-4990 05/01/015 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 transitions.office@frontier.com Phone: (608) 566-81 07/01/015 06/0/017 Fax: (608) 745-1757 07/01/015 06/0/017 11/4/015 Page 19 of 186

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 dmcwilliams@crawfordcountywi.org Phone: (608) 6-056 04/01/014 0/1/016 Fax: (608) 6-495 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/014 0/1/016 CRAWFORD COUNTY HUMAN SERVICES DEPARTMENT Lic #: 159 5 N BEAUMONT ROAD #6 PRAIRIE DU CHIEN, WI 581 Crawford County Surveyor: Cynthia Lindgren DANIEL MCWILLIAMS Initial Cert: 10/01/1975 dmcwilliams@crawfordcountywi.org Phone: (608) 6-056 04/01/014 0/1/016 Fax: (608) 6-495 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

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 foundations@frontier.com Phone: (608) 44-9100 04/01/015 0/1/017 Fax: (608) 44-9099 04/01/015 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 lauraf@arccommserv.com Phone: (608) 8-646 0/01/015 0/8/017 Fax: (608) 8-674 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 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 5590 0/01/015 0/8/017 CATHOLIC CHARITIES, INC., CENTRAL CITY COUNSELING SERVICES Lic #: 117 1810 SOUTH PARK ST SUITE 00 MADISON, WI 571 Dane County JERILYN ROBINSON Initial Cert: 01/01/1979 jrobinson@ccmadison.org Phone: (608) 56-58 05/01/014 04/0/016 Fax: (608) 56-50 05/01/014 04/0/016 1 CATHOLIC CHARITIES, BELOIT OFFICE, SHOPIERE ROAD, BELOIT, WI 5511 05/01/014 01/01/015 1 CATHOLIC CHARITIES, JANESVILLE OFFICE, 00 E MILWAUKEE AVENUE, JANESVILLE, WI 5545 05/01/014 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 5716 09/15/015 04/0/016 09/15/015 04/0/016 09/15/015 04/0/016 CHILD & FAMILY PSYCHOLOGICAL SERVICES CLINIC Lic #: 1174 47 S. YELLOWSTONE DR., #18 MADISON, WI 5719 Dane County NIRA SCHERZ-BUSCH Initial Cert: 07/01/198 nira@charter.net Phone: (608) 88-188 08/01/015 07/1/017 Fax: (608) 88-189 08/01/015 07/1/017 11/4/015 Page 1 of 186

CHILDREN'S SERVICE SOCIETY OF WISCONSIN 1716 FORDEM AVENUE MADISON, WI 5704 Dane County Lic #: 1188 MAUREEN ROBBINS Initial Cert: 0/01/1981 maureen.robbins@cssw.org Phone: (608) 1-511 0/01/015 0/8/017 Fax: (608) 1-514 0/01/015 0/8/017 COMMUNITY SUPPORT NETWORK, INC DBA COLLABORATIONS Lic #: 07 1191 NORTH SHERMAN AVE MADISON, WI 5704 Dane County DEBORAH RAETTIG Initial Cert: 0/18/014 deb.raettig@visitcollaborations.org Phone: (608) 41-9 07/01/015 06/0/017 Fax: (608) 70-8 07/01/015 06/0/017 COMMUNITY SUPPORT NETWORK INC, 117 NORTH SHERMAN AVE, MADISON, WI 5704 07/01/015 06/0/017 CONNECTIONS COUNSELING 5005 UNIVERSITY AVE STE #100 MADISON, WI 5705 Dane County Lic #: 407 SHELLY DUTCH Initial Cert: 01/01/00 shelly.dutch@connectionscounselin Phone: (608) -100 04/01/015 0/1/017 Fax: (608) -101 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/017 04/01/015 0/1/017 1 JEFFERSON CO HUMAN SVS-CONNECTIONS CNSLG, 1541 ANNEX RD, JEFFERSON, WI 5549 04/01/015 0/1/017 1 PRES HOUSE, 71 STATE STREET MALL, MADISON, WI 570 11/0/016 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 simon@countyofdane.com Phone: (608) 4-600 07/01/015 06/0/016 Fax: (608) 4-651 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

DANE COUNTY HUMAN SERVICES DEPT./JOURNEY MENTAL HEALTH CENTER Lic #: 646 70 WEST MAIN ST MADISON, WI 570 Dane County LYNN A. BRADY Initial Cert: 0/01/006 lynn.brady@journeymhc.org Phone: (608) 80-561 0/01/015 0/8/017 Fax: (608) 80-707 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 info@fsmad.org Phone: (608) 5-10 10/01/015 09/0/017 Fax: (608) 5-1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 jeanne@insightmadison.com Phone: (608) 44-4859 06/01/015 05/1/017 Fax: (608) 44-6809 06/01/015 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 Bburns@ids-wi.com Phone: (608) 8-01 10/01/014 09/0/016 Fax: (608) 8-016 INTEGRATED DEVELOPMENT SERVICES, 17 W. DUNWOOD ROAD, FOX POINT, WI 517 10/01/014 09/0/016 10/01/014 09/0/016 JOURNEY MENTAL HEALTH CENTER - FORWARD SOLUTIONS Lic #: 1598 10 MENDOTA ST SUITE 10 MADISON, WI 5714 Dane County KATHY ZAKARIAS Initial Cert: 09/01/1990 katherine.zakarias@journeymhc.org Phone: (608) 80-180 11/01/014 10/1/016 Fax: (608) 80-185 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 Page of 186

JOURNEY MENTAL HEALTH CENTER GATEWAY COMMUNITY SUPPORT PROGRAM Lic #: 1599 14 S PARK STREET MADISON, WI 5715 Dane County JOSH PETERSON Initial Cert: 09/01/1990 josh.peterson@journeymhc.org Phone: (608) 80-150 0/01/015 01/1/017 Fax: (608) 80-160 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 lynn.brady@journeymhc.org Phone: (608) 80-700 0/01/014 0/9/016 Fax: (608) 80-707 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 5716 01/1/015 06/11/015 JOURNEY MENTAL HEALTH CENTER-COMMUNITY TREATMENT ALTERNATIVES CSP Lic #: 159 000 FORDEM AVE MADISON, WI 5704 Dane County DAVE DELAP Initial Cert: 0/01/199 dave.delap@journeymhc.org Phone: (608) 80-740 0/01/014 01/1/016 Fax: (608) 80-775 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/014 01/1/016 JOURNEY MENTAL HEALTH CENTER-YAHARA HOUSE Lic #: 1595 80 E GORHAM STREET MADISON, WI 570 Dane County GAIL MARKER Initial Cert: 10/01/1975 gail.marker@journeymhc.org Phone: (608) 80-4700 0/01/014 01/1/016 Fax: (608) 80-470 MENTAL HEALTH-DAY TREATMENT DHS 61.75 0/01/014 01/1/016 11/4/015 Page 4 of 186

JUVENILE ASSESSMENT AND TREATMENT CENTER, LLC Lic #: 486 45 ATWOOD AVENUE, #10 MADISON, WI 5704 Dane County LORRIE ROLLER Initial Cert: 1/01/00 roller.jatc@sbcglobal.net Phone: (608) 4-8780 1/01/015 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 madisonpc@gmail.com Phone: (608) -07 10/01/014 09/0/016 Fax: (608) -589 10/01/014 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 marriage.solutions@sbcglobal.net Phone: (608) 0-667 06/01/014 05/1/016 Fax: (608) 0-6696 06/01/014 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 DrsBrown@tds.net Phone: (608) 8-9770 04/01/015 0/1/017 Fax: (608) 8-1197 04/01/015 0/1/017 MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM Lic #: 101 0 S. PARK STREET MADISON, WI 5715 Dane County SUSAN JANTY Initial Cert: 01/01/1984 sjanty@meriter.com Phone: (608) 417-546 1/01/014 11/0/016 Fax: (608) 417-54 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 1/01/014 11/0/016 1/01/014 11/0/016 11/4/015 Page 5 of 186

MERITER NEWSTART OUTPATIENT CLINIC 1015 GAMMON LANE MADISON, WI 5719 Dane County Lic #: 1617 SUE JANTY Initial Cert: 01/01/1988 sjanty@meriter.com Phone: (608) 417-8144 1/01/014 11/0/016 Fax: (608) 71-457 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 11/0/016 1/01/014 11/0/016 MERITER'S CHILD & ADOLESCENT PSYCHIATRIC HOSPITAL Lic #: 1668 8001 RAYMOND ROAD MADISON, WI 5719 Dane County SUSAN JANTY Initial Cert: 01/01/1984 SJanty@meriter.com Phone: (608) 417-546 1/01/014 11/0/016 Fax: (608) 417-54 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 1/01/014 11/0/016 NORTHSTAR COUNSELING CENTER 6506 SCHROEDER RD MADISON, WI 5719 Dane County Lic #: 1685 BEN FARBMAN Initial Cert: 11/01/1991 b_farbman@yahoo.com Phone: (608) 70-1960 08/04/015 10/1/016 Fax: (608) 70-1965 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 amy.mosher.garvey@gmail.com Phone: (608) 87-70 09/01/014 08/1/016 Fax: (608) 87-7 09/01/014 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 sparke@orionfamilyservices.org Phone: (608) 70-511 08/01/014 07/1/016 Fax: (608) 70-0467 08/01/014 07/1/016 11/4/015 Page 6 of 186

PROGRAM FOR ASSERTIVE COMMUNITY TREATMENT (PACT) Lic #: 1750 600 WILLIAMSON STREET, #A-B MADISON, WI 570 Dane County JANA LANE FREY Initial Cert: 09/01/1989 Jana.Frey@dhs.wisconsin.gov Phone: (608) 66-071 10/01/015 09/0/017 Fax: (608) 66-68 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 diane.rmhg@gmail.com Phone: (608) 8-586 09/01/015 08/1/017 Fax: (608) 8-11 09/01/015 08/1/017 ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM Lic #: 90 406 SCIENCE DRIVE RM #110 & 00 MADISON, WI 5711 Dane County DAVID GEBAUER Initial Cert: 10/1/010 DGebauer@rogershospital.org Phone: (608) 8-4411 11/01/015 10/1/017 Fax: (608) 8-441 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 11/01/015 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 tzemlo@soarcms.org Phone: (608) 87-089 07/0/015 06/0/016 Fax: (608) 87-0840 07/0/015 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 christina_mignon@ssmhc.com Phone: (608) 58-6707 06/01/014 05/1/016 Fax: (608) 59-517 MENTAL HEALTH-INPATIENT DHS 61.71 06/01/014 05/1/016 11/4/015 Page 7 of 186

THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC Lic #: 1147 510 WALL STREET, #500 MADISON, WI 5718 Dane County KEVIN RANDALL Initial Cert: 0/01/198 christiancounselingmadison@gmail. Phone: (608) 74-894 0/01/014 0/1/016 Fax: (608) 74-878 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 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 BRygiewicz@edgewood.edu Phone: (608) 66-6154 09/01/014 08/1/016 Fax: (608) 664-9854 09/01/014 08/1/016 THE INTEGRAL PSYCHOLOGY CENTER 1619 MONROE ST MADISON, WI 5711 Dane County Lic #: 1914 ARDEN MAHLBERG Initial Cert: 05/01/1979 ipc@integralpsychology.com Phone: (608) 55-90 05/01/014 04/0/016 Fax: (608) 55-7810 05/01/014 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 jhblack@wisc.edu Phone: (608) 8-9991 11/01/014 10/1/016 Fax: (608) 8-199 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/014 10/1/016 11/01/014 10/1/016 1 AIDS NETWORK, 600 WILLIAMSON STREET, MADISON, WI 570 11/01/014 01/1/015 1 THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 1, WISCONSIN DELLS, WI 5965 11/01/014 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 5578 11/01/014 10/1/016 11/01/014 10/1/016 08/5/016 10/1/016 11/4/015 Page 8 of 186

THE RAINBOW PROJECT, INC. 81 E. WASHINGTON AVENUE MADISON, WI 570 Dane County Lic #: 190 SHARYL KATO Initial Cert: 05/01/1988 skato@therainbowproject.net Phone: (608) 55-756 06/01/015 05/1/017 Fax: (608) 55-0457 06/01/015 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 CGreen@uwhealth.org Phone: (608) 6-1111 0/01/014 01/1/016 Fax: (608) 6-9045 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 01/1/016 0/01/014 01/1/016 UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY Lic #: 195 600 HIGHLAND AVE, AOB-414 MADISON, WI 579 Dane County JACKIE SMITH-HELMANSTEIN Initial Cert: 01/01/1987 jsmith-helmanstein@uwhealth.org Phone: (608) 81-499 11/01/015 10/1/017 Fax: (608) 66-050 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/015 10/1/017 WELLSPRING PSYCHOTHERAPY AND COUNSELING CENTER Lic #: 198 5610 MEDICAL CIRCLE, SUITE 5 MADISON, WI 5719 Dane County BRYCE MITCHELL Initial Cert: 07/01/1996 wellspringpsych@charter.net Phone: (608) 74-5888 07/01/015 06/0/017 Fax: (608) 74-5764 07/01/015 06/0/017 WESTSIDE PSYCHOTHERAPY 1 PRICE PLACE, SUITE 08 MADISON, WI 5705 Dane County Lic #: 056 SANDRA EUGSTER Initial Cert: 01/01/015 wsidepsychotherapy@gmail.com Phone: (608) 6-4460 01/01/015 1/1/015 Fax: (608) 6-4461 01/01/015 1/1/015 11/4/015 Page 9 of 186

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 kim.schutt-chardon@wiautism.com Phone: (608) 66-97 05/01/015 04/0/017 Fax: (608) 66-9041 05/01/015 04/0/017 WISCONSIN PSYCHOTHERAPY AND HEALING CENTER Lic #: 000 6401 ODANA ROAD SUITE 1 MADISON, WI 5719 Dane County KAY PHILLIPS Initial Cert: 09/01/199 wisconsinpsychotherapyinc@earthli Phone: (608) 88-80 09/01/014 08/1/016 Fax: (608) 88-8977 09/01/014 08/1/016 COMMON THREADS FAMILY RESOURCE CENTER Lic #: 779 5979 SIGGELKOW ROAD MC FARLAND, WI 5558 Dane County Surveyor: William Rohner ELLEN EGGEN Initial Cert: 04/01/008 info@commonthreadsmadison.org Phone: (608) 88-8999 10/01/015 09/0/017 Fax: (608) 88-8988 10/01/015 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. 6716 STONE GLEN DRIVE MIDDLETON, WI 556 Dane County Lic #: 10 DANIEL SIMON Initial Cert: 0/01/1994 ccr@communitycareresources.com Phone: (608) 87-7100 04/01/015 0/1/017 Fax: (608) 87-7101 04/01/015 0/1/017 1 ADAMS CNTY DEPT H&HS, 108 E. NORTH ST, FRIENDSHIP, WI 594 04/01/015 0/1/017 1 JEFFERSON COUNTY DEPT. OF HUMAN SERVICES, 1541 ANNEX ROAD, JEFFERSON, WI 5549 04/01/015 0/1/017 ROCK CNTY DEPT OF HUMAN SVS, 50 N COUNTY TRK HWY F, JANESVILLE, WI 5547 04/01/015 0/1/017 11/4/015 Page 0 of 186

COMMUNITY COUNSELING CENTER OF MADISON, INC. Lic #: 1 669 UNIVERSITY AVENUE, #09 MIDDLETON, WI 556 Dane County MARY OLSON Initial Cert: 01/01/1998 univavectr@yahoo.com Phone: (608) 8-5880 0/01/014 01/1/016 Fax: (608) 89-787 0/01/014 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 eclipse044@att.net Phone: (608) 1-65 08/01/014 07/1/016 Fax: (608) 1-586 08/01/014 07/1/016 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN Lic #: 18 5900 MONONA DRIVE #100 MONONA, WI 5716 Dane County Surveyor: William Rohner DAN FEASTER Initial Cert: 09/01/1994 dfeaster@aol.com Phone: (608) 66-076 08/01/015 07/1/017 Fax: (608) 66-0765 08/01/015 07/1/017 1 SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN, 109 FIRST STREET, LODI, WI 5555 08/01/015 07/1/017 1 WEST MADISON - GOOD SHEPERD LUTHERAN CHURCH, 5701 RAYMOND RD, MADISON, WI 5711 08/01/015 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 sankofabch@gmail.com Phone: (414) 0-9146 11/01/015 11/0/015 Fax: (608) 819-801 11/01/015 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

TELLURIAN OUTPATIENT CLINIC 00 FEMRITE DR - ND FLOOR MONONA, WI 5716 Dane County Lic #: 1901 SARAH LIM Initial Cert: 04/7/011 slim@tellurian.org Phone: (608) -711 08/01/015 07/1/017 Fax: (608) -5904 CSAS-INTERVENTION DHS 75.16 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 marysella.omhs@gmail.com Phone: (608) 85-5050 08/4/015 04/0/017 Fax: (608) 85-5010 08/4/015 04/0/017 1 OREGON MENTAL HEALTH SERVICES LLC, 110 W. LINDEN DRIVE SUITE B, JEFFERSON, WI 5549 08/4/015 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 5575 08/4/015 04/0/017 08/4/015 04/0/017 08/4/015 04/0/017 OCEANHAWK COUNSELING ALTERNATIVES, LLC Lic #: 675 15 W MAIN STREET, #07A STOUGHTON, WI 5589 Dane County Surveyor: William Rohner JEAN DAUTE Initial Cert: 07/17/006 counseling@oceanhawk.net Phone: (608) 87-788 07/01/015 06/0/017 Fax: (877) 674-177 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/015 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 hkleinbrook@stohosp.com Phone: (608) 87-4 09/01/014 08/1/016 Fax: (608) 87-9 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 08/1/016 09/01/014 08/1/016 11/4/015 Page of 186

HEALING HEARTS FAMILY COUNSELING CENTER, LLC Lic #: 916 168 W MAIN STREET, # SUN PRAIRIE, WI 5590 Dane County PAT ANN ST. GERMAIN Initial Cert: 09/0/010 patann@healingheartscares.com Phone: (608) 84-11 10/01/015 09/0/017 Fax: (608) 84-11 10/01/015 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 prairiec@netzero.net Phone: (608) 87-4814 08/01/014 07/1/016 Fax: (608) 85-49 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: 868 778 LOIS DRIVE SUN PRAIRIE, WI 5590 Dane County TIM PERRY Initial Cert: 08/18/009 tperry@crossroads7.com Phone: (608) 87-911 09/01/015 08/1/017 Fax: (608) 87-9191 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/017 11/4/015 Page of 186

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 exdir@affiliatedcounseling.net Phone: (90) 887-8751 10/01/015 09/0/017 Fax: (90) 887-977 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 1 AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI 5495 10/01/015 09/0/017 AGNESIAN HEALTHCARE, D.B.A. PSYCHIATRIC ASSOCIATES Lic #: 175 00 FRONT STREET, #D BEAVER DAM, WI 5916 Dodge County JIM SALASEK Initial Cert: 10/01/1984 salasekj@agnesian.com Phone: (90) 885-780 07/01/014 06/0/016 Fax: (90) 885-788 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 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 #: 764 199 COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 1/11/007 Aschultz@co.dodge.wi.us Phone: (90) 86-49 1/01/01 11/0/015 Fax: (90) 86-81 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

DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT Lic #: 18 199 COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 10/01/1975 aschultz@co.dodge.wi.us Phone: (90) 86-4094 0/01/015 0/8/017 Fax: (90) 86-81 CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5048 0/01/015 0/8/017 MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI 5050 0/01/015 0/8/017 MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 01, MAYVILLE, WI 5050 0/01/015 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 #: 100 199 COUNTY ROAD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 01/01/1999 Aschultz@co.dodge.wi.us Phone: (90) 86-81 10/01/015 09/0/017 Fax: (90) 86-81 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/015 09/0/017 WATERTOWN PHYSICIAN PRACTICES, LLC DBA WRMC DIRECTIONS COUNSELING CENTER Lic #: 178 19 HOSPITAL DRIVE WATERTOWN, WI 5098 Dodge County ERIC D BEAVER Initial Cert: 11/01/1981 ebeaver@uwhpwatertown.com Phone: (90) 6-4800 09/01/015 1/1/015 Fax: (90) 6-481 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 1/1/015 09/01/015 1/1/015 1 WRMC LAKE MILLS CLINIC, 105 MULBERRY STREET, LAKE MILLS, WI 5551 09/01/015 1/1/015 11/4/015 Page 5 of 186

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 baycounseling@gmail.com Phone: (90) 74-448 07/01/014 06/0/016 Fax: (90) 74-4681 07/01/014 06/0/016 COUNSELING ASSOCIATES OF DOOR COUNTY LLC Lic #: 150 60 N 1TH AVENUE STURGEON BAY, WI 545 Door County WILLIAM G NICK Initial Cert: 11/16/199 cadc@dcwis.com Phone: (90) 74-9554 1/01/014 11/0/016 Fax: (90) 74-1591 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 5401 0/0/015 11/0/016 DOOR COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 18 41 NEBRASKA STREET STURGEON BAY, WI 545 Door County CORI MCFARLANE Initial Cert: 01/01/1978 cmcfarlane@co.door.wi.us Phone: (90) 746-7155 10/01/014 09/0/016 Fax: (90) 746-49 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 #: 159 41 NEBRASKA STREET STURGEON BAY, WI 545 Door County SHERYL FLORES Initial Cert: 10/01/1999 sflores@co.door.wi.us Phone: (90) 746-40 04/01/015 0/1/017 Fax: (90) 746-49 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 11/4/015 Page 6 of 186

DOOR COUNTY DEPT OF HUMAN SERVICES - CCS Lic #: 057 41 NEBRASKA STREET STURGEON BAY, WI 545 Door County CORINNE MCFARLANE Initial Cert: 1/01/014 cmcfarlane@co.door.wi.us Phone: (90) 746-7155 1/01/015 11/0/016 Fax: (90) 746-49 CCS REGIONAL MODEL SHARED SERVICES DHS 6 1/01/015 11/0/016 11/4/015 Page 7 of 186

Douglas County DOUGLAS CO DEPT HLTH & HUMAN SVS/HUMAN DEVELOPMENT CTR Lic #: 964 1500 N 4TH STREET, #00 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong STEVEN ENGLESON Initial Cert: 07/01/010 steve.engleson@hdchrc.org Phone: (715) 9-816 07/01/014 06/0/016 Fax: (715) 9-6055 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/014 06/0/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER Lic #: 14 1500 N 4TH STREET, #00 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong BETSY BYLER Initial Cert: 1/01/198 betsy.byler@hdchrc.org Phone: (715) 9-816 07/01/014 06/0/016 Fax: (715) 9-6055 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 BRYANT ELEMENTARY SCHOOL, 14 CENTRAL AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 COOPER ELEMENTARY, 1807 MISSOURI AVE., SUPERIOR, WI 54880 04/0/016 06/0/016 FOUR CORNERS ELEMENTARY, 4465 COUNTY RD. B, SUPERIOR, WI 54880 04/0/016 06/0/016 GREAT LAKES ELEMENTARY, 19 N. 8TH ST. EAST, SUPERIOR, WI 54880 04/0/016 06/0/016 LAKE SUPERIOR ELEMENTARY, 600 E. RD ST., SUPERIOR, WI 54880 04/0/016 06/0/016 NORTHERN LIGHTS ELEMENTARY, 101 NORTH 8TH ST, SUPERIOR, WI 54880 07/01/014 06/0/016 NORTHWESTERN ELEMENTARY SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI 54854 07/01/014 06/0/016 NORTHWESTERN HIGH SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI 54854 07/01/014 06/0/016 NORTHWESTERN MIDDLE SCHOOL, 105 EAST US HWY, POPLAR, WI 54864 07/01/014 06/0/016 SOLON SPRINGS SCHOOL, 899 EAST BALDWIN AVE, SOLON SPRINGS, WI 5487 07/01/014 06/0/016 SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER COMMUNITY SUPPORT PROGRAM Lic #: 1 1500 N 4TH ST #00 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong STEVE ENGLESON Initial Cert: 1/01/198 steve.engleson@hdchrc.org Phone: (715) 9-816 07/01/014 06/0/016 Fax: (715) 9-6055 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 54880 Douglas County Surveyor: Polly Wong Lic #: 111 DONALD MATTSON Initial Cert: 11/11/015 info@ccgcounseling.com Phone: (715) 718-5606 11/11/015 10/1/016 Fax: (715) 718-5607 11/11/015 10/1/016 11/4/015 Page 8 of 186

Dunn County ARBOR PLACE, INC. 4076 KOTHLOW AVE MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn Lic #: 1050 JILL GAMEZ Initial Cert: 1/01/199 info@arborplaceinc.com Phone: (715) 5-457 10/01/015 09/0/017 Fax: (715) 5-455 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 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 10/01/015 09/0/017 DUNN COUNTY DEPARTMENT OF HUMAN SERVICES BEHAVIORAL HEALTH SERVICES Lic #: 187 001 US HWY 1 EAST, SUITE 160 MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn VICKI RADMANN Initial Cert: 01/01/1981 vradmann@co.dunn.wi.us Phone: (715) 1-706 04/1/015 05/1/016 Fax: (715) -5987 04/1/015 05/1/016 DUNN COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 055 001 US HWY 1 EAST, SUITE 160 MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn JOCELYN LINGEL-KUFNER Initial Cert: 06/01/1998 jlingel@co.dunn.wi.us Phone: (715) -1116 06/01/015 05/1/017 Fax: (715) -5987 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 06/01/015 05/1/017 MAYO CLINIC HEALTH SYSTEM RED CEDAR 411 STOUT ROAD MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn Lic #: 1780 DANIELLE HAUBRICH Initial Cert: 11/01/199 haubrich.danielle@mayo.edu Phone: (715) -7891 11/01/014 10/1/016 Fax: (715) -7897 11/01/014 10/1/016 11/4/015 Page 9 of 186

NORTHWEST DIRECTIONS - MENOMONIE 40 TECHNOLOGY DRIVE EAST MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn Lic #: 94 REBECCA MCCURDY Initial Cert: 07/6/010 nwdmenomonie@nwcgc.com Phone: (715) 5-445 0/01/015 01/1/017 Fax: (715) 5-441 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 54481 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-AMERY, PO BOX 167, 1096 APPLE AVENUE, AMERY, WI 54001 0/01/015 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 5479 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-GREEN BAY, 1 SOUTH VAN BUREN STREET, GREEN BAY, WI 5401 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-SIREN, 7670 JOHNSON STREET, SIREN, WI 5487 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-WAUPACA COUNTY, 10 E MAIN STREET, WEYAUWEGA, WI 5498 0/01/015 01/1/017 1 NORTHWEST DIRECTIONS-WAUSAU, 805 EMERY DRIVE, WAUSAU, WI 54401 0/01/015 11/08/015 1 NORTHWEST DIRECTIONS-WAUSAU, 5665 N 8TH AVENUE, WAUSAU, WI 54401 11/09/015 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 54615 BLACK RIVER FALLS MIDDLE SCHOOL, 10 PIERCE ST, BLACK RIVER FALLS, WI 54615 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 54615 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 54615 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, 164 198TH STREET, JIM FALLS, WI 54748 LAGRANGE ELEMENTARY SCHOOL, 600 STRAW STREET, TOMAH, WI 54660 LEOMONWEIR ELEMENTARY SCHOOL, 711 N. GLENDALE AVENUE, TOMAH, WI 54660 MENOMONIE HIGH SCHOOL, 1715 5TH STREET WEST, MENOMONIE, WI 54751 MENOMONIE MIDDLE SCHOOL, 90 1ST STREET EAST, MENOMONIE, WI 54751 OAKLAWN ELEMENTARY SCHOOL, 500 1ST STREET SE, MENOMONIE, WI 54751 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 54751 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 54615 TOMAH MIDDLE SCHOOL, 61 HOLLISTER AVENUE, TOMAH, WI 54660 WAKANDA ELEMENTARY SCHOOL, 1801 WAKANDA STREET NE, MENOMONIE, WI 54751 WEBSTER ELEMENTARY SCHOOL, 764 ALDER STREET WEST, WEBSTER, WI 5489 WEBSTER MIDDLE & HIGH SCHOOL, 7564 ALDER STREET WEST, WEBSTER, WI 5489 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 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

NORTHWEST JOURNEY - MENOMONIE 40 TECHNOLOGY DRIVE EAST MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn Lic #: 660 REBECCA MCCURDY Initial Cert: 0/01/006 RebeccaM@nwgc.com Phone: (715) 5-445 0/01/014 0/9/016 Fax: (715) 5-441 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

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 Kristin@aurismandbehaviorcenter.c Phone: (715) 598-711 09/08/015 05/1/016 Fax: (715) 598-71 09/08/015 05/1/016 FIRST THINGS FIRST COUNSELING & CONSULTING Lic #: 148 519 N HILLCREST PKWY STE 01 ALTOONA, WI 5470 Eau Claire County Surveyor: Roderic Senn CHASTITY DRAKE Initial Cert: 09/01/1990 chastitydrake@hotmail.com Phone: (715) 8-84 08/01/015 07/1/017 Fax: (715) 8-5007 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 07/1/017 08/01/015 07/1/017 CAILLIER CLINIC, LTD. 60 STEIN BLVD EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 1119 PAUL CAILLIER Initial Cert: 01/01/198 caillier1@aol.com Phone: (715) 86-0064 05/18/015 11/0/016 Fax: (715) 86-0065 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/18/015 11/0/016 05/18/015 11/0/016 1 CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 10, MENOMONIE, WI 54751 05/18/015 11/0/016 CAILLIER CLINIC, LTD, 0 NORTH MAIN STREET, RICE LAKE, WI 54868 05/18/015 11/0/016 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 004 HIGHLAND AVE SUITE N EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 1186 KRISTINE PARKINS Initial Cert: 09/01/198 Kristine.Parkins@cssw.org Phone: (715) 85-5915 01/01/014 1/1/015 Fax: (715) 85-811 01/01/014 1/1/015 DAVEY ELEMENTARY, 000 STARR AVE, EAU CLAIRE, WI 5470 01/01/014 1/1/015 LOCUST LANE ELEMENTARY, 45 LOCUST LANE, EAU CLAIRE, WI 5470 01/01/014 1/1/015 MANZ ELEMENTARY, 1000 EAST FILLMORE AVE, EAU CLAIRE, WI 54701 01/01/014 1/1/015 ROOSEVELT ELEMENTARY SCHOOL, 010-8TH STREET, EAU CLAIRE, WI 5470 01/01/014 1/1/015 11/4/015 Page 4 of 186

CLINIC FOR CHRISTIAN COUNSELING, LLC 505 S DEWEY, #08 EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 701 PHILIP KOESTLER Initial Cert: 01/0/007 pkoestler@cccwi.org Phone: (715) 8-1678 01/01/014 1/1/015 Fax: (715) 8-6680 CLINIC FOR CHRISTIAN COUNSELING, LLC, 1 W MARSHALL STREET, #104, RICE LAKE, WI 54868 01/01/014 1/1/015 01/01/014 1/1/015 CRESTVIEW ACADEMY, 1519 PETERSON AVE, EAU CLAIRE, WI 54701 01/01/014 1/1/015 EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 815 71 OXFORD AVENUE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn RON HON Initial Cert: 09/09/008 Ron.hon@co.eau-claire.wi.us Phone: (715) 89-100 09/01/015 08/1/017 Fax: (715) 81-5658 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/015 08/1/017 EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: 19 71 OXFORD AVENUE EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn RON HON Initial Cert: 01/01/1990 Ron.Hon@co.eau-claire.wi.us Phone: (715) 89-690 0/01/014 0/9/016 Fax: (715) 81-578 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 matter@clinicarecorp.com Phone: (715) 84-6681 09/01/015 08/1/017 Fax: (715) 84-447 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

LSS OF WI & UPPER MI FAMILY PRESERVATION PROGRAM Lic #: 797 10 S BARSTOW STREET EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn MIKE BAUER Initial Cert: 07/0/008 mike.bauer@lsswis.org Phone: (715) 8-1 07/01/015 06/0/017 Fax: (715) 88-84 07/01/015 06/0/017 1 LSS OF WI & UPPER MI FAMILY PRESERVATION, 115 N 6TH STREET, WAUSAU, WI 5440 07/01/015 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

MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: 156 95 MONDOVI ROAD EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn THOMAS JOHNSTON Initial Cert: 09/01/198 mfhsec@sbcglobal.net Phone: (715) 8-08 05/01/014 04/0/016 Fax: (715) 8-0771 05/01/014 04/0/016 11/4/015 Page 45 of 186

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 5479 05/01/014 04/0/016 1 MARRIAGE & FAMILY HEALTH SERVICES, 50 BUFFALO STREET, MONDOVI, WI 54755 05/01/014 0/09/015 1 MARRIAGE & FAMILY HEALTH SERVICES, 905-7TH AVE WEST, DURAND, WI 5476 05/01/014 04/0/016 1 MARRIAGE & FAMILY HEALTH SERVICES, P O BOX 517407 S ND STREET, ALMA, WI 54610 05/01/014 04/0/016 MARRIAGE & FAMILY HEALTH SERVICES, 105 WEST AVENUE, RICE LAKE, WI 54868 MARRIAGE & FAMILY HEALTH SERVICES, 910 ENLOE ST, HUDSON, WI 54016 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 54770 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 54701 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 54701 MFHS- OAK LAWN ELEMENTARY SCHOOL, 500 1ST STREET SOUTH, MENOMONIE, WI 54751 MFHS- PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI 54701 MFHS- SOUTH MIDDLE SCHOOL, 115 MITSCHER AVE, EAU CLAIRE, WI 54701 MFHS- TURTLE LAKE ELEMENTARY MID & HIGH SCHOOLS, 05 OAK STREET NORTH, TURTLE LAKE, W MFHS-ANDREW TAINTER ELEMENTARY, 01 CARRIE AVE, RICE LAKE, WI 54868 MFHS-BRUCE MIDDLE & HIGH SCHOOL, 104 W. WASHINGTON AVENUE, BRUCE, WI 54819 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, 1000 8TH 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 54011 MFHS-ELLSWORTH MIDDLE SCHOOL, 1 WEST PANTHER DRIVE, ELLSWORTH, WI 54011 MFHS-HAUGEN ELEMENTARY, 615 W 5TH STREET, HAUGEN, WI 54841 MFHS-HILCREST ELEMENTARY, 100 MILES STREET, CHIPPEWA FALLS, WI 5479 MFHS-HILLCREST ELEMENTARY, 50 SOUTH GRANT STREET, ELLSWORTH, WI 54011 MFHS-HILLTOP ELEMENTARY, 0 CAMERON ROAD, RICE LAKE, WI 54868 MFHS-JEFFERSON ELEMENTARY, 0 PHIPPS AVENUE, RICE LAKE, WI 54868 MFHS-JIM FALLS ELEMENTARY, 164-198TH STREET, JIM FALLS, WI 54748 MFHS-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET, LADYSMITH, WI 54848 MFHS-MEADOWVIEW ELEMENTARY, 4714 FAIRFAX STREET, EAU CLAIRE, WI 54701 MFHS-MENOMONIE MIDDLE SCHOOL, 90 1ST STREET SE, MENOMONIE, WI 54751 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 775-170TH AVENUE, HAGER CITY, WI 54014 MFHS-RICE LAKE HIGH SCHOOL, 0 SOUTH WISCONSIN, RICE LAKE, WI 54868 MFHS-RICE LAKE MIDDLE SCHOOL, 04 CAMERON ROAD, RICE LAKE, WI 54868 MFHS-RIVER FALLS HIGH SCHOOL, 818 CEMETERY RD., RIVER FALLS, WI 540 MFHS-ROBBINS ELEMENTARY, 8 E. HAMILTON AVENUE, EAU CLAIRE, WI 54701 05/01/014 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

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 54751 MFHS-WOODLAND ELM SCHOOL, 808 E WOODLAND AVE, BARRON, WI 5481 0/16/015 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 #: 0 1000 STARR AVENUE EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn CHRISTINE GUTSCH Initial Cert: 0/14/000 gutsch.criss@marshfieldclinic.org Phone: (715) 858-4859 07/01/015 06/0/017 Fax: (715) 858-451 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 5479 07/01/015 06/0/017 1 EAU CLAIRE CENTER, 116 CRAIG RD, EAU CLAIRE, WI 54701 07/01/015 06/0/017 1 LAKE HALLIE CENTER, 1961 7TH AVE, CHIPPEWA FALLS, WI 5479 07/01/015 06/0/017 1 MARSHFIELD CLINIC - LADYSMITH CENTER, 906 COLLEGE AVENUE, WEST, LADYSMITH, WI 54848 07/01/015 06/0/017 MARSHFIELD CLINIC - LAKEWOODS CENTER, 115 WEST KNAPP ST, RICE LAKE, WI 54868 07/01/015 06/0/017 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC Lic #: 1511 11 WHIPPLE STREET EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn KARLENE PHILLIPS Initial Cert: 06/01/1981 phillips.karlene@mayo.edu Phone: (715) 88-74 1/01/014 11/0/016 Fax: (715) 88-649 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 1/01/014 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 Ming.Cindy@mayo.edu Phone: (715) 88-569 01/01/015 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 54758 07/07/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM-BLOOMER CLINIC, 1501 THOMPSON STREET, BLOOMER, WI 5474 01/01/015 1/1/015 MAYO CLINIC HEALTH SYSTEM NORTHLAND, 1 S MAIN STREET, RICE LAKE, WI 54868 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

SACRED HEART BEHAVIORAL HEALTH CLINIC 45 SOUTHTOWNE DRIVE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 947 KIM JOHNSON Initial Cert: 10/1/011 kim.johnson@hshs.org Phone: (715) 717-5899 10/01/014 09/0/016 Fax: (715) 717-5898 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 54701 10/01/014 09/0/016 SACRED HEART HOSPITAL 900 W. CLAIREMONT AVENUE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 09 THERESA MACKEY Initial Cert: 0/01/198 theresa.mackey@hshs.org Phone: (715) 717-47 01/01/015 1/1/016 Fax: (715) 717-4996 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/015 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 #: 1408 005 HIGHLAND AVE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn MARK BJERKE Initial Cert: 08/01/1990 bjerkem@vantagepointclinic.com Phone: (715) 84-171 09/01/014 08/1/016 Fax: (715) 84-174 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 1 VANTAGE POINT CLINIC & ASSESSMENT CENTER, 54 GOLF ROAD, SUITE #F, EAU CLAIRE, WI 547 10/01/015 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 54701 PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI 54701 RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI 54868 RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI 54868 ROBBINS ELEMENTARY, 8 E. HAMILTON AVE, EAU CLAIRE, WI 54701 WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVENUE, BARRON, WI 5481 09/01/014 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

WISCONSIN EARLY AUTISM PROJECT, INC. 15 HEIGHTS DRIVE SUITE F EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 440 KIM SCHUTT-CHARDON Initial Cert: 05/1/00 Kim.Schutt-Chardon@wiautism.com Phone: (715) 8-06/01/015 05/1/017 Fax: (715) 8-1666 06/01/015 05/1/017 11/4/015 Page 49 of 186

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 rogers-dolle@agnesian.com Phone: (90) 907-801 07/01/015 06/0/017 Fax: (90) 907-809 07/01/015 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 meyera@deltactr.com Phone: (90) 91-4 01/01/015 1/1/016 Fax: (90) 91-0989 01/01/015 1/1/016 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS Lic #: 150 459 E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/01/1978 community.programs@fdlco.wi.gov Phone: (90) 99-500 01/01/014 1/1/015 Fax: (90) 99-19 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 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 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS Lic #: 680 459 E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/18/006 rebecca.bell@fdlco.wi.gov Phone: (90) 99-71 08/01/015 07/1/017 Fax: (90) 99-19 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 08/01/015 07/1/017 11/4/015 Page 50 of 186

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 minervacounselingcenter@gmail.co Phone: (90) 9-507 1/01/014 11/0/016 Fax: (90) 9-508 1/01/014 11/0/016 ST. AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES Lic #: 1847 40 EAST DIVISION STREET FOND DU LAC, WI 5495 Fond Du Lac County JAMES SALASEK PHD Initial Cert: 05/01/1980 salasekj@agnesian.com Phone: (90) 96-400 01/01/014 1/1/015 Fax: (90) 96-89 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 01/01/014 1/1/015 1 ST AGNES HOSPITAL BEHAVIORAL HEALTH SVS, 60 BROWN STREET, WAUPUN, WI 596 01/01/014 1/1/015 ST AGNES HOSPITAL BEHAV HLTH, 790 EASTGATE DRIVE, RIPON, WI 54971 ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI 54971 01/01/014 06/18/015 06/19/015 1/1/015 Forest County FOREST COUNTY POTAWATOMI BEHAVIORAL HEALTH DEPARTMENT Lic #: 151 801 MISH KO SWEN DRIVE CRANDON, WI 5450 Forest County TINA GARCIA Initial Cert: 04/01/1994 tina.garcia@fcpotawatomi-nsn.gov Phone: (715) 478-4 04/01/015 0/1/017 Fax: (715) 478-449 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 Debra.Hilgart@ssc-nsn.gov Phone: (715) 478-5180 0/01/015 1/1/015 Fax: (715) 478-5904 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 1/1/015 0/01/015 1/1/015 11/4/015 Page 51 of 186

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 cknapp@unifiedservices.org Phone: (608) 7-657 07/01/015 06/0/017 Fax: (608) 7-4417 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 #: 1941 00 W. ALONA LANE LANCASTER, WI 581 Grant County Surveyor: Cynthia Lindgren CHERYL KNAPP Initial Cert: 07/01/1994 cknapp@unifiedservices.org Phone: (608) 7-657 10/01/014 09/0/016 Fax: (608) 7-4417 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. 1155 N ELM STREET, #10 PLATTEVILLE, WI 5818 Grant County Surveyor: Cynthia Lindgren Lic #: 178 MARC K. WRUBLE Initial Cert: 09/08/1995 drwruble@gmail.com Phone: (608) 48-4060 10/01/014 09/0/016 Fax: (608) 48-4191 1 PLATTEVILLE FAMILY RESOURCE CENTER, INC, 15701 COUNTY K, DARLINGTON, WI 550 1 PLATTEVILLE FAMILY RESOURCE CENTER, INC, 880 HWY 5 & 61, LANCASTER, WI 581 10/01/014 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

SOUTHWEST BEHAVIORAL SERVICES 1185 NORTH ELM STREET PLATTEVILLE, WI 5818 Grant County Surveyor: Cynthia Lindgren Lic #: 197 HEATHER JOHNSON Initial Cert: 0/01/000 johnsonh@southwesthealth.org Phone: (608) 48-656 0/01/015 0/9/016 Fax: (608) 4-05 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 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 5805 0/01/015 0/9/016 1 GOOD SAMARITAN HOME, 1850-11TH STREET, FENNIMORE, WI 5809 0/01/015 0/9/016 1 GRAY'S NURSING HOME, 555 NORTH CHESTNUT ST, PLATTEVILLE, WI 5818 0/01/015 0/9/016 1 HCR MANOR CARE, 100 NORTH WATER ST, PLATTEVILLE, WI 5818 0/01/015 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 5565 0/01/015 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 5581 0/01/015 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 5807 0/01/015 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

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 gholcomb@gchsd.org Phone: (608) 8-99 01/01/014 1/1/015 Fax: (608) 8-9480 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 gchsd@gchsd.org Phone: (608) 8-99 01/01/014 1/1/015 Fax: (608) 8-9480 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 sfarrey@gchsd.org Phone: (608) 8-910 06/01/015 05/1/016 Fax: (608) 8-9480 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 550 06/01/015 05/1/016 MONROE CLINIC BEHAVIORAL HEALTH 515 - ND AVENUE MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren Lic #: 1915 TROY WHITEMAN Initial Cert: 05/01/1981 troy.whiteman@monroeclinic.org Phone: (608) 4-1914 08/01/015 07/1/017 Fax: (608) 4-10 08/01/015 07/1/017 1 MONROE CLINIC - FREEPORT BRANCH, 101 KIWANIS DRIVE, FREEPORT, IL 610 08/01/015 07/1/017 1 MONROE CLINIC - NEW GLARUS BRANCH, 1800 - ND ST, NEW GLARUS, WI 5574 08/01/015 07/1/017 11/4/015 Page 54 of 186

Green Lake County GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: 189 571 COUNTY ROAD A GREEN LAKE, WI 54941 Green Lake County LINDA VAN NESS Initial Cert: 04/01/1977 Lvanness@co.green-lake.wi.us Phone: (90) 94-4070 11/01/014 10/1/016 Fax: (90) 94-419 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS 75.04 CSAS-PREVENTION WITH TELEHEALTH DHS 75.04 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 #: 65 571 COUNTY ROAD A GREEN LAKE, WI 54941 Green Lake County LINDA VAN NESS Initial Cert: 11/01/000 Lvanness@co.green-lake.wi.us Phone: (90) 94-4070 11/01/014 10/1/016 Fax: (90) 94-419 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 #: 599 571 COUNTY ROAD A GREEN LAKE, WI 54941 Green Lake County LINDA VAN NESS Initial Cert: 08//005 Lvanness@co.green-lake.wi.us Phone: (90) 94-4070 10/01/015 0/1/016 Fax: (90) 94-419 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

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 cknapp@unifiedservices.org Phone: (608) 95-776 07/01/015 06/0/017 Fax: (608) 95-174 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/015 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 kolsonc@ironcountywi.org Phone: (715) 561-66 07/01/015 06/0/016 Fax: (715) 561-18 CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES Lic #: 47 00 TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/00 ironcountyhsd@ironcountywi.org Phone: (715) 561-66 04/01/015 0/8/017 Fax: (715) 561-18 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS 75.04 CSAS-PREVENTION WITH TELEHEALTH DHS 75.04 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 54547 04/01/015 0/8/017 HURLEY SCHOOL DISTRICT, 550 W RANGE VIEW DR, HURLEY, WI 5454 MERCER SCHOOL DISTRICT, 690 W MARGARET STREET, MERCER, WI 54547 04/01/015 0/8/017 04/01/015 0/8/017 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES COMM SUPPORT PROGRAM Lic #: 745 00 TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/007 ironcountyhsd@ironcountywi.org Phone: (715) 561-66 04/01/015 0/8/017 Fax: (715) 561-18 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/8/017 11/4/015 Page 56 of 186

Jackson County HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH Lic #: 141 W9850 AIRPORT RD BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn TERRY GREENDEER Initial Cert: 05/01/199 Terry.greendeer@ho-chunk.com Phone: (715) 84-9851 11/01/014 10/1/016 Fax: (715) 84-44 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/014 10/1/016 11/01/014 10/1/016 NEKOOSA HEALTH OFFICE, 15 1ST STREET, NEKOOSA, WI 54457 11/01/014 10/1/016 THREE RIVERS HOUSE, 74 MAIN STREET, LA CROSSE, WI 54601 11/01/014 10/1/016 TOMAH HEALTH OFFICE, 774 HWY 1 EAST, TOMAH, WI 54660 11/01/014 10/1/016 WELLNESS CENTER HEALTH OFFICE, S845 WHITE EAGLE ROAD, BARABOO, WI 591 11/01/014 10/1/016 WITTENBERG HEALTH OFFICE, N740 HWY 49 NORTH, WITTENBERG, WI 54499 11/01/014 10/1/016 JACKSON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 901 40 HIGHWAY 54 WEST BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn BETH SMETANA Initial Cert: 05/01/010 Beth.smetana@co.jackson.wi.us Phone: (715) 84-401 05/01/014 04/0/016 Fax: (715) 84-771 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 JACKSON COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: 957 40 HIGHWAY 54 WEST BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn HEATHER L. HAINZ Initial Cert: 01/01/01 heather.hainz@co.jackson.wi.us Phone: (715) 84-401 09/01/015 08/1/016 Fax: (715) 84-771 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 08/1/016 09/01/015 08/1/016 KROHN CLINIC, LTD. 610 W ADAMS STREET BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn Lic #: 147 SHERIE SPAULDING BH MGR Initial Cert: 0/01/1988 spauldings@krohnclinic.com Phone: (715) 84-1901 05/01/015 04/0/017 Fax: (715) 84-1890 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/015 04/0/017 05/01/015 04/0/017 11/4/015 Page 57 of 186

NORTHWEST JOURNEY - BLACK RIVER FALLS N664 COUNTY ROAD A BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn Lic #: 655 JEN STEINKE Initial Cert: 0/01/006 Jens@nwcgc.com Phone: (715) 84-1100 0/01/015 01/1/017 Fax: (715) 84-1145 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 Sue800@gmail.com Phone: (507) 450-697 07/01/014 06/0/016 Fax: (507) 961-059 07/01/014 06/0/016 11/4/015 Page 58 of 186

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 jrobinson@ccmadison.com Phone: (90) 56-58 0/01/014 0/9/016 Fax: (608) 56-50 0/01/014 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 lawrence.miller@forthc.com Phone: (90) 56-954 0/01/014 01/1/016 Fax: (90) 568-6047 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 5549 0/01/014 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 kathic@jeffersoncountywi.gov Phone: (90) 674-105 06/01/014 05/1/016 Fax: (90) 674-611 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 #: 1 1541 ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner MAJORIE THORMAN Initial Cert: 06/01/000 marjt@jeffersoncountywi.gov Phone: (90) 674-8198 06/01/014 05/1/016 Fax: (90) 674-7409 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 06/01/014 05/1/016 11/4/015 Page 59 of 186

JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 64 1541 ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner KIMBERLY PROPP Initial Cert: 0/15/006 kimp@jeffersoncountywi.gov Phone: (90) 674-877 0/01/015 0/8/017 Fax: (90) 674-59 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 jschmidt1611@familyresourcesinc.c Phone: (90) 61-4100 11/01/014 10/1/016 Fax: (90) 61-8801 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/014 10/1/016 11/01/014 10/1/016 FAMILY RESOURCES ASSOCIATES INC, 1 N MAIN STREET, LAKE MILLS, WI 5551 11/01/014 10/1/016 11/4/015 Page 60 of 186

Juneau County JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 145 0 E LACROSSE STREET MAUSTON, WI 5948 Juneau County JOANN GEIGER Initial Cert: 01/01/1988 jgeiger@co.juneau.wi.us Phone: (608) 847-9474 01/01/014 1/1/015 Fax: (608) 847-941 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 #: 000 0 E LA CROSSE STREET RM # MAUSTON, WI 5948 Juneau County JOANN GEIGER Initial Cert: 04/01/01 jgeiger@co.juneau.wi.us Phone: (608) 847-9474 04/01/015 0/1/017 Fax: (608) 847-941 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM Lic #: 145 0 E LACROSSE STREET MAUSTON, WI 5948 Juneau County MARY JO ONSAGER Initial Cert: 01/01/1989 monsager@co.juneau.wi.us Phone: (608) 847-9550 1/01/015 11/0/017 Fax: (608) 847-9576 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page 61 of 186

Kenosha County AALTO ENHANCEMENT CENTER, SC 850-75TH STREET, #A KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 108 KATHRYN A. AALTO Initial Cert: 04/09/1991 aecaalto@tds.net Phone: (6) 654-970 05/01/015 04/0/017 Fax: (6) 654-979 05/01/015 04/0/017 AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES Lic #: 18 15-71ST STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATE CONNELLY Initial Cert: 09/4/1998 Kate.Connelly@aurora.org Phone: (414) 454-6506 10/01/015 09/0/017 Fax: (414) 454-6450 10/01/015 09/0/017 1 AURORA BEHAVIORAL HEALTH SVS-KENOSHA NORTH, 6811 118TH PL., KENOSHA, WI 5140 10/01/015 09/0/017 1 AURORA BEHAVIORAL HEALTH SVS-RACINE WEST, 848 WASHINGTON AVE., RACINE, WI 5405 10/01/015 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 gretchen.huletz@cssw.org Phone: (6) 65-55 10/01/015 09/0/017 Fax: (6) 65-778 10/01/015 09/0/017 WALWORTH COUNTY CHILD ADVOCACY CENTER, W406 HWY, NN, ELKHORN, WI 511 10/01/015 09/0/017 INTERCONNECTIONS, S.C. 90-60TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner Lic #: 1440 DEBORAH BISSLAND Initial Cert: 08/01/1981 jbrand04@wi.rr.com Phone: (6) 654-5 01/01/015 1/1/016 Fax: (6) 654-7818 01/01/015 1/1/016 11/4/015 Page 6 of 186

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 mmihajlovic@kenoshachc.org Phone: (6) 656-0044 05/01/015 05/0/016 Fax: (6) 65-18 05/01/015 05/0/016 1 KENOSHA COMMUNITY HEALTH CENTER - 5ND ST. CLINIC, 10 5ND STREET, KENOSHA, WI 5140 05/01/015 05/0/016 KENOSHA COMMUNITY HEALTH CENTER - 14TH AVE CLINIC, 66 14TH AVENUE, KENOSHA, WI 514 05/01/015 05/0/016 KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 589 8600 SHERIDAN RD #100 KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATIE HANKS Initial Cert: 05/01/005 katie.hanks@kenoshacounty.org Phone: (6) 697-4648 05/01/015 04/0/017 Fax: (6) 697-4655 CCS REGIONAL MODEL SHARED SERVICES DHS 6 05/01/015 04/0/017 KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), 5407 8TH AVENUE, KENOSHA, WI 5140 05/01/015 04/0/017 KENOSHA COUNTY DEPT OF HUMAN SERVICES/KENOSHA HUMAN DEVELOPMENT SERVICES INC Lic #: 1460 5407 8TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner KARI FOSS Initial Cert: 0/01/1977 kfoss@khds.org Phone: (6) 657-7188 05/01/014 04/0/016 Fax: (6) 65-080 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 KENOSHA HUMAN DEVELOPMENT SERVICES, INC Lic #: 941 71 55TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner TRACY FRENCH Initial Cert: 10/01/01 Tfrench@khds.org Phone: (6) 84-058 11/01/015 09/0/016 Fax: (6) 84-059 11/01/015 09/0/016 KENOSHA HUMAN DEVELOPMENT SERVICES, INC COMMUNITY SUPPORT PROGRAM Lic #: 897 5407 8TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner LISA A HAEN, MS Initial Cert: 01/01/010 khds@khds.com Phone: (6) 657-7188 01/01/015 1/1/016 Fax: (6) 65-080 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/015 1/1/016 11/4/015 Page 6 of 186

MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. Lic #: 61 650 SHERIDAN ROAD, # KENOSHA, WI 514 Kenosha County Surveyor: William Rohner TONY MOORE Initial Cert: 09/14/005 Tmoore@mooreandassociates.biz Phone: (6) 605-1444 10/01/015 09/0/017 Fax: (6) 605-1404 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 OAKWOOD CLINICAL ASSOCIATES, LTD. 4109-67TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 08 AMY ANDERSON Initial Cert: 0/5/1991 amyanderson@oakwoodclinical.com Phone: (6) 65-980 0/01/014 0/9/016 Fax: (6) 65-91 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 OAKWOOD CLINICAL ASSOCIATES LTD, 470-75TH ST, PADDOCK LAKE, WI 5168 0/01/014 0/9/016 PROFESSIONAL SERVICES GROUP, INC. 108 6RD STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 1749 BRIAN WOLF Initial Cert: 06/01/198 bwolf@psgcip.com Phone: (6) 65-406 04/01/014 0/1/016 Fax: (6) 65-408 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 1 PROFESSIONAL SERVICES GROUP, 74 ELM STREET, WEST BEND, WI 5095 09/01/014 0/1/016 1 PROFESSIONAL SERVICES GROUP, 800 GOOLD, RACINE, WI 540 07/9/014 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 5105 04/01/014 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 pauldefazio@wi.rr.com Phone: (6) 654-0487 05/01/014 04/0/016 Fax: (6) 654-44 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/014 04/0/016 05/01/014 04/0/016 11/4/015 Page 64 of 186

ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM Lic #: 4 9916-75TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner JODY PAHLAVAN PSY.D. Initial Cert: 04/8/00 jpahlavan@rogershospital.org Phone: (6) 94-4000 05/01/014 04/0/016 Fax: (6) 94-7740 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 61.75 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 #: 1466 810 LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON, PHD Initial Cert: 0/01/1977 jacobsom@kewauneeco.org Phone: (90) 88-700 0/01/015 01/1/017 Fax: (90) 88-7044 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 #: 88 810 LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County LAURA BORKOVETZ Initial Cert: 0/01/1977 borkovel@kewauneeco.org Phone: (90) 88-700 0/01/015 01/1/017 Fax: (90) 88-7044 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 0/01/015 01/1/017 KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: 781 810 LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON Initial Cert: 0/11/008 jacobsom@kewauneeco.org Phone: (90) 88-704 04/01/014 0/1/016 Fax: (90) 88-7044 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

La Crosse County COUNSELING ASSOCIATES LLC 115-5TH AVENUE SOUTH, #01 LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 80 MARIO EINSMAN Initial Cert: 06/05/008 einsman@hbci.com Phone: (608) 785-087 06/01/015 05/1/016 Fax: (608) 785-07 COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN 55987 06/01/015 05/1/016 06/01/015 05/1/016 DRIFTLESS RECOVERY SERVICES INC Lic #: 01 444 MAIN ST SUITE 01 LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn BRETT KNUTSON Initial Cert: 04/14/014 bknutson@driftlessrecovery.com Phone: (608) 519-5908 04/01/015 0/1/017 Fax: (608) 519-5909 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/017 04/01/015 0/1/017 FAMILY AND CHILDREN'S CENTER 1707 MAIN STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 115 VANESSA SOUTHWORTH Initial Cert: 0/01/1994 vsouthworth@fccnetwork.org Phone: (608) 785-0001 11/01/015 10/1/017 Fax: (608) 785-000 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 54665 11/01/015 10/1/017 11/4/015 Page 66 of 186

GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH Lic #: 191 186 SOUTH AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/1984 skmelde@gundersenhealth.org Phone: (608) 775-649 1/01/014 11/0/016 Fax: (608) 775-6055 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,, 18606 ERVIN STREET, WHITEHALL, WI 5477 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 6 NORTH ND STREET, LA CRESCENT, MN 55947 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 805 MAIN AVE SOUTH, HARMONY, MN 5599 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA 5175 1/01/014 11/0/016 1 GUNDERSON CLINIC LTD, 5791 OSSEO ROAD, INDEPENDENCE, WI 54747 1/01/014 11/0/016 1 GUNDERSON CLINIC LTD, 40 SOUTH PETERSON AVE, BLAIR, WI 54616 1/01/014 11/0/016 1 LA CROSSE CO LAKEVIEW HEALTH CENTER, 90 GARLAND STREET, E, WEST SALEM, WI 54669 1/01/014 11/0/016 1 RICHLAND MEDICAL CENTER, 01 EAST ND STREET, RICHLAND CENTER, WI 5581 1/01/014 11/0/016 1 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 54665 1/01/014 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 54660 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI 54656 GUNDERSEN LUTHERAN MEDICAL CENTER, 1-16TH AVE SOUTH, ONALASKA, WI 54650 GUNDERSEN LUTHERAN MEDICAL CENTER, 111 GUNDERSEN DRIVE, ONALASKA, WI 54650 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 LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH Lic #: 150 1910 SOUTH AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/198 skmelde@gundersenhealth.org Phone: (608) 775-649 1/01/014 11/0/016 Fax: (608) 775-6055 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-NARCOTIC TREATMENT DHS 75.15 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 1/01/014 11/0/016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI 54656 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 1-16TH AVENUE SOUTH, ONALASKA, WI 54650 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 18606 ERVIN STREET, WHITEHALL, WI 5477 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 111 GUNDERSEN DRIVE, ONALASKA, WI 54650 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI 54660 1/01/014 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

LA CROSSE COUNTY HUMAN SERVICES 00 N 4TH STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 1488 BEV TRUSSONI Initial Cert: 0/01/1978 btrussoni@@lacrossecounty.org Phone: (608) 785-6107 05/01/014 04/0/016 Fax: (608) 785-61 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 54669 10/01/015 04/0/016 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN HEALTHCARE Lic #: 170 700 WEST AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn NAN ANDERSON Initial Cert: 09/01/1977 anderson.nanette@mayo.edu Phone: (608) 9-647 04/01/015 0/1/017 Fax: (608) 9-976 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 04/01/015 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 54601 La Crosse County Surveyor: Roderic Senn LACIE ANTHONY Initial Cert: 09/01/1977 Anthony.Lacie@mayo.edu Phone: (608) 9-9555 06/01/015 05/1/017 Fax: (608) 9-979 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS 61.75 06/01/015 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 5461 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 10 MAIN STREET, HOLMEN, WI 5466 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 54650 06/01/015 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 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SIENA HALL, 608 S 11TH STREET, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SPARTA, 10 W. MAIN ST, SPARTA, WI 54656 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - TOMAH, 5 BUTTS AVENUE, TOMAH, WI 54660 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - VILLA SUCCES, 11 PRAIRIE STREET, PRAIRIE DU CHIEN, WI 581 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - WOMEN'S LAAR HOUSE, 1005 JACKSON STREET, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 700 WEST AVENUE SOUTH, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 54601 06/01/015 05/1/017 11/4/015 Page 68 of 186

PEACE OF MIND COUNSELING 115-5TH AVENUE SOUTH, SUITE 507 LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 005 JAY CLARK Initial Cert: 08/01/01 jayc@hbci.com Phone: (608) 797-5679 08/01/014 07/1/016 Fax: 1 PEACE OF MIND CNSLNG - WINONA MN, 111 MARKET ST, SUITE 4A, WINONA, MN 55987 08/01/014 07/1/016 08/01/014 0/8/015 PEACE OF MIND CNSLNG - WINONA MN, 90 E. ND ST., STE., WINONA, MN 55987 CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI 54601 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 54601 EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 5466 G-E-T ELEMENTARY SCHOOL - GALESVILLE, 17151 FRENCH RD, GALESVILLE, WI 5460 G-E-T HIGH SCHOOL, 17511 NORTH MAIN ST, GALESVILLE, WI 5460 G-E-T MIDDLE SCHOOL, 19650 PRAIRIE RIDGE LANE, GALESVILLE, WI 5460 HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI 54601 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 55947 LA CRESCENT MS/HS, 101 LANCER BLVD, LA CRESCENT, MN 55947 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650 ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI 54650 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 54658 VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI 5466 0/01/015 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 cskolnik@lacrossecounty.org Phone: (608) 785-6019 07/01/015 06/0/016 Fax: (608) 785-61 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 54656 07/01/015 06/0/016 11/4/015 Page 69 of 186

WESTERN REGION INTEGRATED CARE CONSORTIUM (WRIC) CSP Lic #: 058 1707 MAIN STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn KATHY ROHR Initial Cert: 11/01/014 krohr@fccnetwork.org Phone: (608) 785-0001 01/01/015 1/1/015 Fax: (608) 785-000 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 54656 01/01/015 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 5465 0/16/015 1/1/015 01/01/015 0/15/015 01/01/015 1/1/015 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH Lic #: 80 1-16TH AVENUE, SOUTH ONALASKA, WI 54650 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/000 skmelde@gundersenhealth.org Phone: (608) 775-87 1/01/014 11/0/016 Fax: (608) 775-8661 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 1/01/014 11/0/016 1/01/014 11/0/016 LIVING WELL CHRISTIAN FAMILY CLINIC, LLC 575 LESTER AVENUE STE #100 ONALASKA, WI 54650 La Crosse County Surveyor: Roderic Senn Lic #: 778 PHILIP KOESTLER Initial Cert: 04/01/008 staff@livingwellcfc.com Phone: (608) 78-145 04/01/015 0/1/017 Fax: (608) 78-1456 04/01/015 0/1/017 STEIN COUNSELING AND CONSULTING SERVICES, LTD Lic #: 467 571 BRAUND STREET ONALASKA, WI 54650 La Crosse County Surveyor: Roderic Senn TED STEIN Initial Cert: 08/06/00 tstein@effectivebehavior.com Phone: (608) 785-7000 09/01/015 08/1/017 Fax: (608) 785-7477 EAGLE BLUFF ELEMENTARY, 00 EAGLE BLUFF COURT, ONALASKA, WI 54650 NORTHERN HILLS ELEMENTARY, 511 SPRUCE ST, ONALASKA, WI 54650 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650 09/01/015 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

Lafayette County LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 1490 67 N MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 10/01/1975 SSchuhmacher@lchsd.org Phone: (608) 776-4800 11/01/015 10/1/017 Fax: (608) 776-4914 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 79 67 N MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 11/01/000 sschuhmacher@lchsd.org Phone: (608) 776-4800 11/01/015 10/1/016 Fax: (608) 776-4914 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 54409 Langlade County Surveyor: Polly Wong Lic #: 890 SYLVIA DENNISON MD Initial Cert: 07/7/010 sylviad@aspirus.org Phone: (715) 67-6100 08/01/015 07/1/017 Fax: (715) 67-618 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 5448 09/0/016 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 drnat@frontiernet.net Phone: (715) 75-94 07/01/015 06/0/017 Fax: (715) 75-4510 07/01/015 06/0/017 11/4/015 Page 71 of 186

Lincoln County ANDERSON & ASSOCIATES COUNSELING AND PSYCHOLOGIST SERVICES Lic #: 59 71 EAST SECOND ST MERRILL, WI 5445 Lincoln County Surveyor: Polly Wong BREEZY BONNEVILLE Initial Cert: 04/01/004 cwpsmerrill@hotmail.com Phone: (715) 59-8080 04/01/015 0/1/017 Fax: (715) 59-8099 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/017 04/01/015 0/1/017 PSYCHOLOGICAL RESOURCE CENTER, LLC 118 N 4TH STREET, #108 TOMAHAWK, WI 54487 Lincoln County Surveyor: Polly Wong Lic #: 806 ELIZABETH K MCCLUSKEY Initial Cert: 10/01/008 betty@psychresctr.com Phone: (715) 4-100 10/01/014 09/0/016 Fax: (715) 4-106 10/01/014 09/0/016 1 FOREST COUNTY COURTHOUSE, 00 EAST MADISON STREET, CRANDON, WI 5450 11/5/014 09/0/016 TOMAHAWK SCHOOLS, 1048 EAST KING RD, TOMAHAWK, WI 54487 10/01/014 09/0/016 11/4/015 Page 7 of 186

Manitowoc County MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT Lic #: 1555 96 S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 humanservices@co.manitowoc.wi.u Phone: (90) 68-40 11/01/015 10/1/017 Fax: (90) 68-44 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 85 96 S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 humanservices@co.manitowoc.wi.u Phone: (90) 68-40 11/01/015 10/1/017 Fax: (90) 68-44 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 #: 711 96 S. 8TH STREET MANITOWOC, WI 541 Manitowoc County JEFF JENSWOLD Initial Cert: 0/06/007 humanservices@co.manitowoc.wi.u Phone: (90) 68-40 0/01/015 0/9/016 Fax: (90) 68-44 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 drteiden@gmail.com Phone: (90) 68-111 11/01/014 10/1/016 Fax: (90) 68-5087 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/014 10/1/016 11/01/014 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 110 LINCOLN ST, WISCONSIN RAPIDS, WI 54494 08/5/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 111 NORTH 7TH STREET, SHEBOYGAN, WI 5081 01/01/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 807 CENTER STREET, SHEBOYGAN, WI 5081 11/01/014 1/1/014 11/4/015 Page 7 of 186

AURORA BEHAVIORAL HEALTH CENTER - MANITOWOC Lic #: 186 500 MEMORIAL DRIVE TWO RIVERS, WI 5441 Manitowoc County TRACY LINDBERG Initial Cert: 09/01/199 tracy.lindberg@aurora.org Phone: (90) 79-79 04/01/014 0/1/016 Fax: (608) 79-791 04/01/014 0/1/016 11/4/015 Page 74 of 186

Marathon County COURAGE TO CHANGE RECOVERY 106 GALVIN ROAD ABBOTSFORD, WI 54405 Marathon County Surveyor: Polly Wong Lic #: 180 RAE ANN WICHLACZ Initial Cert: 01/07/000 wichlacz@pcpros.net Phone: (715) -0480 11/01/015 10/1/017 Fax: (715) -1611 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/015 10/1/017 11/01/015 10/1/017 1 COURAGE TO CHANGE RECOVERY, 880 E PERKINS, #10, MEDFORD, WI 54451 11/01/015 10/1/017 COURAGE TO CHANGE RECOVERY, 188 N LAKE AVENUE, PO BOX, PHILLIPS, WI 54555 CHEQUAMEGON HIGH SCHOOL, 400 9TH STREET, NORTH, PARK FALLS, WI 5455 11/01/015 10/1/017 11/01/015 10/1/017 ACHIEVE CENTER 50 NORTH 8TH AVE, #00 WAUSAU, WI 54401 Marathon County Surveyor: Polly Wong Lic #: 719 CAROL WESLEY Initial Cert: 04/01/007 cwesley@uachievecenter.com Phone: (715) 845-4900 04/01/014 0/1/016 Fax: (715) 845-4970 04/01/014 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 chd@chdevelopment.org Phone: (715) 84-0944 1/01/015 11/0/017 Fax: (715) 845-6477 1 CENTER FOR HUMAN DEVELOPMENT INC, 1509 N FOURTH ST, SUITE, TOMAHAWK, WI 54487 1 CENTER FOR HUMAN DEVELOPMENT, 417 POST ROAD, SUITE H, STEVENS POINT, WI 54481 1 CENTER FOR HUMAN DEVELOPMENT, 4 S CENTRAL STREET, #109, MARSHFIELD, WI 54449 1/01/015 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 54487 1/01/015 11/0/017 CHARIS COUNSELING, LLC 60 W. STEWART AVENUE, #10 WAUSAU, WI 54401 Marathon County Surveyor: Polly Wong Lic #: 464 LORI THOMPSON Initial Cert: 09/01/00 lthompson@chariscounselingwi.com Phone: (715) 848-055 09/01/014 08/1/016 Fax: (715) 848-8665 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 54449 09/01/014 08/1/016 11/4/015 Page 75 of 186

CHILDREN'S SERVICE SOCIETY OF WISCONSIN 705 S. 4TH AVENUE, #40 WAUSAU, WI 54401 Marathon County Surveyor: Polly Wong Lic #: 1185 GRETCHEN HINTZ Initial Cert: 1/01/198 Gretchen.Hintz@cssw.org Phone: (715) 848-1457 01/01/014 1/1/015 Fax: (715) 848-959 01/01/014 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 5448 04/9/014 1/1/015 JEFFERSON ELEMENTARY, 1800 EAST AVE, STEVENS POINT, WI 54481 MADISON ELEMENTARY, 600 MARIA DRIVE, STEVENS POINT, WI 54481 MARSHFIELD HIGH SCHOOL, 1401 EAST BECKER ROAD, MARSHFIELD, WI 54449 MCDILL ELEMENTARY, 516 SCHOOL STREET, STEVENS POINT, WI 54481 MCKINLEY ELEMENTARY, 96 BLAINE STREET, STEVENS POINT, WI 54481 NEILLSVILLE ELEMENTARY SCHOOL, 504 EAST FIFTH STREET, NEILLSVILLE, WI 54456 NEILLSVILLE HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456 10/15/014 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 tracypetersonccw@gmail.com Phone: (715) 845-549 04/01/014 0/1/016 Fax: (715) 848-5645 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU LLC, 19 SUPERIOR ST, ANTIGO, WI 54409 04/01/014 1/1/014 1 COMPASS COUNSELING WAUSAU LLC, 60 E WALL STREET, EAGLE RIVER, WI 5451 04/01/014 0/1/015 1 COMPASS COUNSELING WAUSAU, LLC, 1004 FIRST ST, STE, STEVENS POINT, WI 54481 10/0/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 50 8TH ST S, WISCONSIN RAPIDS, WI 54494 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 86 S. SUPERIOR ST., STE 109, ANTIGO, WI 54409 04/0/015 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 5910 09/19/014 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 54401 Marathon County Surveyor: Polly Wong Lic #: 49 MICHAEL DIX Initial Cert: 0/01/001 dgcounseling@outlook.com Phone: (715) 675-888 0/01/014 01/1/016 Fax: (715) 675-988 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 01/1/016 0/01/014 01/1/016 11/4/015 Page 76 of 186

ELMERGREEN ASSOCIATES, INC. 114 GRAND AVENUE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 199 DENNIS ELMERGREEN Initial Cert: 11/05/199 elmer5440@yahoo.com Phone: (715) 845-7175 11/01/015 10/1/017 Fax: (715) 845-714 11/01/015 10/1/017 1 ELMERGREEN ASSOCIATES, 11 N. MAIN STREET, MARION, WI 54950 11/01/015 10/1/017 ELMERGREEN ASSOCIATES, INC, 607 E ELIZABETH STREET, SHAWANO, WI 54166 11/01/015 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 adassow@norcen.org Phone: (715) 848-4600 0/01/015 0/8/017 Fax: (715) 845-6050 CSAS-AMBULATORY DETOXIFICATION DHS 75.08 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 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 61.79 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 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 54409 0/01/015 0/8/017 MERRILL CENTER, 607 N SALES STREET, #09, MERRILL, WI 5445 0/01/015 0/8/017 TOMAHAWK OFFICE, 1 WEST WISCONSIN AVE, TOMAHAWK, WI 54487 0/01/015 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 ehuffman@norcen.org Phone: (715) 848-4 01/01/015 1/1/016 Fax: (715) 841-5146 CCS REGIONAL MODEL UNIFIED BOARD DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 15 LANGLADE ROAD, ANTIGO, WI 54409 01/01/015 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

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 ehuffman@norcen.org Phone: (715) 848-4600 01/01/015 1/1/016 Fax: (715) 841-5146 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE CSP - LANGLADE, 15 LANGLADE ROAD, ANTIGO, WI 54409 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE CSP - LINCOLN, 607 N. SALES STREET SUITE 09, MERRILL, WI 5445 01/01/015 1/1/016 NORTHWEST JOURNEY - WAUSAU 5655 N 8TH AVENUE WAUSAU, WI 54401 Marathon County Surveyor: Polly Wong Lic #: 404 AMY MARTHALER Initial Cert: 09/18/00 amym@nwcgc.com Phone: (715) 675-5454 11/09/015 01/1/017 Fax: (715) 675-0545 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 Lee@peacefulsolutions.org Phone: (715) 675-458 0/01/014 0/9/016 Fax: (715) 675-78 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 1 PEACEFUL SOLUTIONS COUNSELING, 76 EAST ND STREET, MERRILL, WI 5445 0/01/014 0/9/016 EDGAR MIDDLE/HIGH SCHOOL, 0 E. BIRCH STREET, EDGAR, WI 5446 0/5/015 0/9/016 PRIMARY CONNECTION HEALTH CARE, INC. DBA BRIDGE COMMUNITY HEALTH CLINIC Lic #: 879 1810 N SECOND STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong JENNIFER SMITH Initial Cert: 08/01/009 jennifersm@bridgeclinic.org Phone: (715) 848-4884 08/01/014 07/1/016 Fax: (715) 845-585 08/01/014 07/1/016 1 ASPIRUS WESTON CLINIC, 4005 COMMUNITY CENTER DRIVE, WESTON, WI 54476 08/01/014 07/1/016 1 BRIDGE CLINIC @ ASPIRUS BEHAV MED CLINIC, 500 FOREST STREET, WAUSAU, WI 5440 08/01/014 07/1/016 11/4/015 Page 78 of 186

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 noreen.salzman@hotmail.com Phone: (715) 848-50 09/01/015 08/1/017 Fax: (888) 778-6750 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 08/1/017 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 1415 EAGLE STREET, RHINELANDER, WI 54501 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 01 N CENTER AVE, MERRILL, WI 5445 09/01/015 08/1/017 LAC DU FLAMBEAU ELEMENTARY SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI 5458 09/01/015 08/1/017 ASPIRUS BEHAVIORAL MEDICINE CLINIC 4005 COMMUNITY CENTER DRIVE WESTON, WI 54476 Marathon County Surveyor: Polly Wong Lic #: 75 PAMELA HOFF Initial Cert: 0/01/007 pamela.hoff@aspirus.org Phone: (715) 41-546 0/01/015 0/8/017 Fax: (715) 41-5448 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 54401 0/01/015 0/8/017 11/4/015 Page 79 of 186

Marinette County MARINETTE AND OCONTO COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: 074 500 HALL AVE MARINETTE, WI 5414 Marinette County JESSICA BEAUCHAMP Initial Cert: 10/01/015 jbeauchamp@marinettecounty.com Phone: (715) 7-7700 10/01/015 09/0/016 Fax: (715) 7-7711 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 5415 10/01/015 09/0/016 MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT Lic #: 1559 500 HALL AVENUE MARINETTE, WI 5414 Marinette County ROBERT VALENTINE Initial Cert: 01/01/198 rvalentine@marinettecounty.com Phone: (715) 7-7760 1/01/015 11/0/017 Fax: (715) 7-7711 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54151 1/01/015 11/0/017 MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT CSP Lic #: 40 500 HALL AVENUE, #A MARINETTE, WI 5414 Marinette County CANDACE BREAULT Initial Cert: 01/01/198 cbreault@marinettecounty.com Phone: (715) 7-7700 1/01/015 11/0/017 Fax: (715) 7-7667 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/015 11/0/017 11/4/015 Page 80 of 186

Marquette County MARQUETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 0 480 UNDERWOOD AVE MONTELLO, WI 5949 Marquette County MANDY STANLEY Initial Cert: 01/1/015 mstanley@co.marquette.wi.us Phone: (608) 97-14 11/01/015 11/0/015 Fax: (608) 97-8718 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 ncs@northlandcommunityservices.c Phone: (608) 96-19 11/01/015 10/1/016 Fax: (608) 96-1590 11/01/015 10/1/016 1 NORTHLAND COMMUNITY SERVICES, 19 S MAIN, PO BOX 1178, ADAMS, WI 5910 11/01/015 10/1/016 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 6 161 SPRING STREET WESTFIELD, WI 5964 Marquette County DR JON MATTHEW Initial Cert: 01/01/198 ncs@northlandcommunityservices.c Phone: (608) 96-19 11/01/01 10/1/015 Fax: (608) 96-1590 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/01 10/1/015 11/4/015 Page 81 of 186

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 amyz@co.menominee.wi.us Phone: (715) 799-861 05/01/015 04/0/017 Fax: (715) 799-517 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 rachelk@co.menominee.wi.us Phone: (715) 799-861 05/01/015 04/0/017 Fax: (715) 799-517 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 stevee@mtclinic.net Phone: (715) 799-5451 0/01/015 0/8/017 Fax: (715) 799-99 0/01/015 0/8/017 11/4/015 Page 8 of 186

REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC Lic #: 88 4550 W BRADLEY ROAD BROWN DEER, WI 5 CANDICE LIPSKI Initial Cert: 09/01/009 reachmentalhealthclinic@hotmail.co Phone: (414) 961-1600 09/01/014 08/1/016 Fax: (414) 961-1616 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT Lic #: 5 4555 W SCHROEDER DRIVE BROWN DEER, WI 5 Surveyor: Merrilee Follensbee JESSICA PITRE Initial Cert: 07/1/004 jpitre@rogershospital.org Phone: (414) 55-9000 07/01/015 06/0/017 Fax: (414) 55-9665 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 61.75 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 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) 865-500 04/8/015 0/1/016 Fax: (6) 646-10 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 04/8/015 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 #: 1867 5900 S. LAKE DRIVE CUDAHY, WI 5110 NORMAN SHANKS Initial Cert: 11/01/1989 Norman.shanks@aurora.org Phone: (414) 489-415 10/01/014 09/0/016 Fax: (414) 489-4056 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/014 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

AURORA BEHAVIORAL HEALTH - FRANKLIN 900 W. LOOMIS ROAD, #17 FRANKLIN, WI 51 Lic #: 1650 KATHERINE CONNELLY Initial Cert: 05/0/1994 Kate.Connelly@aurora.org Phone: (414) 454-6506 05/01/015 04/0/017 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/015 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 #: 17 8800 SOUTH 10ND ST #10 FRANKLIN, WI 51 Surveyor: Merrilee Follensbee JODI PETERNEL Initial Cert: 0/11/1991 pepetjodi@hotmail.com Phone: (414) 858-1014 0/01/014 01/1/016 Fax: (414) 858-1017 0/01/014 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 administration@allianceifs.com Phone: (414) 55-5594 08/01/015 07/1/017 Fax: (414) 751-5166 08/01/015 07/1/017 GREENSQUARE DEVELOPMENTAL SPECIALISTS Lic #: 747 6791 N GREEN BAY ROAD GLENDALE, WI 509 TRACY CLEMENS Initial Cert: 08/17/007 tclemens@chw.org Phone: (414) 8-4800 08/01/014 07/1/016 Fax: (414) 47-0894 08/01/014 07/1/016 GREENSQUARE DEVELOPMENTAL SPECIALISTS, 700 SOUTH 1TH STREET, OAK CREEK, WI 5154 08/01/014 07/1/016 11/4/015 Page 84 of 186

NORTH SHORE PSYCHOTHERAPY ASSOCIATES 5800 N BAYSHORE DRIVE #A50 GLENDALE, WI 517 Surveyor: Merrilee Follensbee Lic #: 168 DANIELA JARAMILLO Initial Cert: 07/01/1980 npsychotherapy@yahoo.com Phone: (414) 96-6764 10/01/014 09/0/016 Fax: (414) 96-6765 10/01/014 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 lgodec@shorehavenbhi.com Phone: (414) 540-170 07/01/014 06/0/016 Fax: (414) 540-171 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 515 07/01/014 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 5188 06/01/015 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 6 DURAND AVE #F, RACINE, WI 5406 07/01/014 06/0/016 STRESS MANAGEMENT & MENTAL HEALTH CLINICS Lic #: 1886 55 N. IRONWOOD LANE, #10 GLENDALE, WI 517 DR. CRAIG MODELL Initial Cert: 10/01/1997 stressmh@att.net Phone: (414) 96-9156 04/01/014 0/1/016 Fax: (414) 96-456 04/01/014 0/1/016 BELL THERAPY COMMUNITY SUPPORT PROGRAM SOUTH Lic #: 1095 440 SOUTH 108TH STREET GREENFIELD, WI 58 DOUGLAS HIGBIE Initial Cert: 0/0/1997 dhigbie@phoenixcaresystems.com Phone: (414) 8-4486 08/01/015 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

16TH STREET BEHAVIORAL HEALTH CENTER 10 S. 16TH STREET MILWAUKEE, WI 504 Lic #: 1011 MARIA PEREZ Initial Cert: 10/15/1997 maria.perez@sschc.org Phone: (414) 67-15 11/01/014 10/1/016 Fax: (414) 8-5597 11/01/014 10/1/016 1 PARKWAY CLINIC, 906 S 0TH STREET, MILWAUKEE, WI 515 11/01/014 10/1/016 1 WAUKESHA COMMUNITY HEALTH CENTER, 09 E. NORTH STREET, WAUKESHA, WI 5188 11/01/014 10/1/016 A STRONG FOUNDATION COUNSELING SERVICES, LLC Lic #: 98 4447 N OAKLAND AVENUE MILWAUKEE, WI 511 NEAOKIA COLLINS Initial Cert: 11/06/01 ncollins@astrongfoundationss.org Phone: (414) 967-7990 1/01/015 10/1/016 Fax: (414) 967-7991 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 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 afreund@amhclinic.com Phone: (414) 871-9111 08/01/015 07/1/017 Fax: (414) 871-911 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 507 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 6040 WEST LISBON AVE STE #10, MILWAUKEE, WI 507 08/01/015 07/1/017 ACHIEVEMENT ASSOCIATES, LTD. 11040 WEST BLUEMOUND RD MILWAUKEE, WI 56 Lic #: 1010 NEENA FLORSHEIM Initial Cert: 07/01/199 AALTEAM@aol.com Phone: (6) 41-5099 06/01/015 05/1/017 Fax: (6) 41-5054 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/015 05/1/017 06/01/015 05/1/017 11/4/015 Page 86 of 186

ADKINS COUNSELING SERVICES 6001 W CENTER STREET #105 MILWAUKEE, WI 510 Lic #: 844 MARCELLA ADKINS Initial Cert: 01//009 adkinscounseling@yahoo.com Phone: (414) 9-1099 01/01/014 1/1/015 Fax: (414) 9-977 01/01/014 1/1/015 AIDS RESOURCE CENTER OF WISCONSIN 80 N. PLANKINTON AVENUE MILWAUKEE, WI 50 Lic #: 406 KEVIN ROEDER Initial Cert: 10/0/00 Kevin.Roeder@arcw.org Phone: (414) 5-1540 01/01/015 1/0/016 Fax: (414) 5-168 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 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 5140 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-LA CROSSE, 505 KING STREET, LA CROSSE, WI 54601 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WISCONSIN, 6 C WEST WISCONSIN AVE, APPLETON, WI 54911 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI 5440 01/01/015 1/0/016 1 AIDS RESOURCE ENTER OF WI-EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI 547 01/01/015 1/0/016 1 ARCW, 16 W. GRAND AVENUE, BELOIT, WI 5511 0/01/015 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 5401 01/01/015 1/0/016 AMRI COUNSELING SERVICES, LLC 4001 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 875 LAKEIA JONES Initial Cert: 08/01/009 amricounseling@yahoo.com Phone: (414) 810-6691 08/01/014 07/1/016 Fax: (866) 719-04 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/014 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 514 08/9/014 07/1/016 11/4/015 Page 87 of 186

AURORA BEHAVIORAL HEALTH - NORTH SHORE Lic #: 15 6980 N. PORT WASHINGTON, #0 MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 08/01/1985 kate.connelly@aurora.org Phone: (414) 454-6506 08/01/014 07/1/016 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 1 AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER STREET, HARTFORD, WI 507 08/01/014 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 5095 08/01/014 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 kate.connelly@aurora.org Phone: (414) 454-6506 01/01/014 1/1/015 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/014 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 robert.marrs@aurora.org Phone: (414) 45-4940 08/01/014 07/1/016 Fax: (414) 4-56 08/01/014 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 504 11/18/016 07/1/016 HOPKINS LLOYD COMMUNITY SCHOOL, 150 W. HOPKINS STREET, MILWAUKEE, WI 506 11/18/016 07/1/016 KAGEL ELEMENTARY SCHOOL, 110 W. MINERAL STREET, MILWAUKEE, WI 504 11/18/016 07/1/016 NEXT DOOR FOUNDATION, 545 N. 9TH STREET, MILWAUKEE, WI 510 11/18/016 07/1/016 WEST SIDE ACADEMY, 1945 N. 1ST STREET, MILWAUKEE, WI 508 11/18/016 07/1/016 BELL THERAPY SOUTH 68TH STREET 858 SOUTH 68TH STREET MILWAUKEE, WI 519 Lic #: 5 JILL LETIZIA Initial Cert: 07/01/000 jletizia@phoenixcaresystems.com Phone: (414) 445-9180 09/01/014 07/1/016 Fax: (414) 445-5995 MENTAL HEALTH-DAY TREATMENT DHS 61.75 09/01/014 07/1/016 11/4/015 Page 88 of 186

BELL THERAPY INC DAY ONE 4065 N 5TH STREET MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee Lic #: 1096 JILL LETIZIA Initial Cert: 10/01/1987 jletizia@phoenixcaresystems.com Phone: (414) 445-9180 04/01/015 0/1/017 Fax: (414) 445-5995 MENTAL HEALTH-DAY TREATMENT DHS 61.75 04/01/015 0/1/017 BELL THERAPY INC COMMUNITY SUPPORT PROGRAM NORTH Lic #: 109 499 W FOND DU LAC AVENUE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee DOUG HIGBIE Initial Cert: 09/01/1990 dhigbie@phoenixcaresystems.com Phone: (414) 871-61 04/01/015 0/1/017 Fax: (414) 871-55 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM Lic #: 456 15 W WELLS STREET, #700 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee JOAN KOJIS Initial Cert: 01/15/00 jkojis@benedictcenter.org Phone: (414) 47-1774 01/01/016 1/1/017 Fax: (414) 47-0148 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/016 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 cydoutpatient@yahoo.com Phone: (414) 6-85 06/01/015 05/1/016 Fax: (414) 64-64 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/015 05/1/016 06/01/015 05/1/016 06/01/015 05/1/016 CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE, INC. Lic #: 11 01 N. 60TH STREET MILWAUKEE, WI 508 Surveyor: Merrilee Follensbee MANDY BIBO Initial Cert: 06/01/1981 mbibo@ccmke.org Phone: (414) 769-415 05/01/015 04/0/017 Fax: (414) 769-48 05/01/015 04/0/017 11/4/015 Page 89 of 186

CENTER FOR QUALITY COMMUNITY LIFE, INC. (CQCL) Lic #: 969 680 W VILLARD AVENUE, #00 MILWAUKEE, WI 518 KATHY CARTER Initial Cert: 08/01/01 Kcarter@cqcl.org Phone: (414) 464-0578 08/01/014 07/1/016 Fax: (414) 464-115 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 CHILD, ADOLESCENT, FAMILY & MARRIAGE THERAPY ASSOCIATES Lic #: 1177 0 W WELLS ST, STE 60 MILWAUKEE, WI 50 EMMA WILLIAMS Initial Cert: 0/01/1995 childadoltherapy@aol.com Phone: (414) 7-5005 04/01/015 0/1/017 Fax: (414) 7-760 04/01/015 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 lwolf@chw.org Phone: (414) 66-91 01/01/015 1/1/016 Fax: (414) 66-75 01/01/015 1/1/016 CHILDREN'S HOSPITAL OF WISCONSIN 9000 W. WISCONSIN AVENUE MILWAUKEE, WI 56 Lic #: 1179 LYNN WOLF Initial Cert: 10/01/1978 lwolf@chw.org Phone: (414) 66-80 1/01/014 11/0/016 Fax: (414) 66-6669 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 5151 1/01/014 11/0/016 11/4/015 Page 90 of 186

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 ann.rolling@cssw.org Phone: (414) 45-1400 01/01/014 1/1/015 Fax: (414) 45-58 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 wfry@columbia-stmarys.org Phone: (414) 585-160 01/01/014 1/1/015 Fax: (414) 585-1969 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 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 COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE CAMPUS Lic #: 115 01 N LAKE DRIVE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM L. FRY Initial Cert: 07/01/015 wfry@columbia-stmarys.org Phone: (414) 91-550 07/01/015 06/0/016 Fax: (414) 91-551 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/015 06/0/016 07/01/015 06/0/016 COMPREHENSIVE CLINICAL & CONSULTING SERVICES INC Lic #: 1 7161 N PORT WASHINGTON RD MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee JESSICA JARDAS Initial Cert: 01/01/198 im@izymat.com Phone: (414) 5-768 09/01/014 08/1/016 Fax: (414) 5-765 09/01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 1616 NORTH CASALOMA DR, APPLETON, WI 5491 09/01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 595 DEVELOPMENT DRIVE, GREEN BAY, WI 5411 09/01/014 08/1/016 1 CCCS AT ADVANCED PAIN MANAGEMENT, 9697 ST CATHERINE'S DRIVE, PLEASANT PRAIRIE, WI 515 09/01/014 08/1/016 1 COMPREHENSIVE CLINICAL & CONSULTING SVS, 416 OLD GREEN BAY ROAD, RACINE, WI 540 09/01/014 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

DLO PARTNERS LLC DBA BRIGHTSIDE MENTAL HEALTH Lic #: 016 07 S CHASE AVE MILWAUKEE, WI 507 JEFF SCHULZ Initial Cert: 0/01/014 jeff.schulz@scasmg.com Phone: (414) 755-4419 0/01/015 0/9/016 Fax: (414) 755-4410 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 ebbtidetherapy@att.net Phone: (414) 7-71 0/01/015 01/1/017 Fax: (414) 7-71 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 01/1/017 0/01/015 01/1/017 EMPATHETIC COUNSELING SERVICES INC. 5501 W BURLEIGH ST MILWAUKEE, WI 510 Lic #: 95 TANYA BROUGHTON LEWIS Initial Cert: 1/01/011 empatheticcounseling@gmail.com Phone: (414) 88-5617 1/01/014 11/0/016 Fax: (414) -5 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 fokusfamilyservices@yahoo.com Phone: (414) 64-417 04/01/014 0/9/016 Fax: (414) 64-418 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/8/015 04/01/014 0/9/016 04/01/014 0/9/016 11/4/015 Page 9 of 186

FORWARD CHOICES LLC 6040 W LISBON AVENUE, #10 MILWAUKEE, WI 510 Surveyor: Merrilee Follensbee Lic #: 785 MICHAEL WALLNER Initial Cert: 05/14/008 forwardchoicesllc@att.net Phone: (414) 44-1751 05/01/015 04/0/017 Fax: (414) 44-1775 05/01/015 04/0/017 GATEWAY TO CHANGE 19 W. CAPITOL DRIVE MILWAUKEE, WI 506 Lic #: 479 GLENDA HAMPTON Initial Cert: 10/9/00 gatewaytochange19@gmail.com Phone: (414) 44-0 1/01/014 11/0/016 Fax: (414) 44-167 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 Gina.Singletery@CorizonHealth.com Phone: (414) 44-406 1/01/015 11/0/017 Fax: (414) 44-0107 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 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 lignace@gliihc.net Phone: (414) 8-956 08/01/015 07/1/017 Fax: (414) 649-719 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

GRO FAMILY SERVICES 6400 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 80 GREGORY OWENS Initial Cert: 08/8/008 acc_gro@yahoo.com Phone: (414) 445-1400 08/01/015 07/1/017 Fax: (414) 95-4716 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 506 08/01/015 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 kristen@guesthouseofmilwaukee.or Phone: (414) 45-40 08/01/015 07/1/017 Fax: (414) 45-58 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 Emily@hhcppo.com Phone: (414) 76-549 1/01/015 11/0/017 Fax: (414) 76-977 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 icbs014@yahoo.com Phone: (414) 49-574 04/01/015 0/1/016 Fax: (414) 49-876 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/016 04/01/015 0/1/016 11/4/015 Page 94 of 186

JEWISH FAMILY SERVICES 100 N JACKSON STREET MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 1450 RACHEL NELSON Initial Cert: 06/01/1979 rnelson@jfsmilw.org Phone: (414) 90-5800 06/01/014 05/1/016 Fax: (414) 90-5808 1 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 chyrat@lacausa.org Phone: (414) 90-1500 05/01/015 04/0/017 Fax: (414) 771-7497 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/015 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 lighthouseclinic@gmail.com Phone: (414) 964-900 0/01/014 01/1/016 Fax: (414) 964-4816 0/01/014 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 olockett@wi.rr.com Phone: (414) 89-8994 08/01/015 07/1/016 Fax: (414) -07 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 07/1/016 08/01/015 07/1/016 08/01/015 07/1/016 11/4/015 Page 95 of 186

M & S CLINICAL SERVICES, INC. 81 NORTH 4TH ST #516 MILWAUKEE, WI 51 Lic #: 1546 MARK FOSSIE Initial Cert: 1/04/1996 fossiem@sbcglobal.net Phone: (414) 6-6000 04/01/015 0/8/017 Fax: (414) 6-70 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 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 tinawilliamsanford@att.net Phone: (414) 788-6 01/01/015 1/1/015 Fax: (414) 9-049 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA Lic #: 1580 1155 N MAYFAIR ROAD MILWAUKEE, WI 56 JEFFREY G MILLER Initial Cert: 07/01/1996 jgmiller@mcw.edu Phone: (414) 955-8900 0/01/015 01/1/017 Fax: (414) 955-685 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 mdtherapybh@aol.com Phone: (414) 466-04 01/01/015 05/1/016 Fax: (414) 466-06 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 05/1/016 01/01/015 05/1/016 11/4/015 Page 96 of 186

MEDINA'S WAY 6815 WEST CAPITAL DRIVE #0 MILWAUKEE, WI 516 Lic #: 979 SHARON MEDINA Initial Cert: 09/18/01 medinasway@gmail.com Phone: (414) 461-005 09/01/015 08/1/017 Fax: (414) 44-45 09/01/015 08/1/017 1 MEDINAS WAY, 1101-1107 WEST NATIONAL AVE, MILWAUKEE, WI 504 09/01/015 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 cullstrup@metahouse.org Phone: (414) 96-100 1/01/015 11/0/017 Fax: (414) 96-05 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 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 #: 19 1040 S. 70TH STREET MILWAUKEE, WI 514 TIM MCGUIRE Initial Cert: 09/01/1985 timothy.mcguire@mfci.net Phone: (414) 476-9675 11/01/015 05/1/017 Fax: (414) 615-067 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/015 05/1/017 11/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 057 S 14TH STREET, MILWAUKEE, WI 504 11/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI 518 11/01/015 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 507 11/01/015 05/1/017 1 TRANSITIONAL LIVING SERVICES INC, 710 DOUGLAS AVENUE, RACINE, WI 540 11/01/015 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 #: 15 1040 S. 70TH STREET MILWAUKEE, WI 514 JOHN CHIANELLI Initial Cert: 09/01/1985 john.chianelli@mcfi.net Phone: (414) 476-9675 11/01/015 06/0/017 Fax: (414) 615-067 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 06/0/017 11/4/015 Page 97 of 186

MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION Lic #: 16 9455 WATERTOWN PLANK ROAD MILWAUKEE, WI 56 JENNIFER BERGERSEN Initial Cert: 08/01/1977 Jbergersen@milwcnty.com Phone: (414) 57-747 11/01/015 10/1/017 Fax: (414) 57-8119 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 11/01/015 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 #: 164 901 WATERTOWN PLANK ROAD MILWAUKEE, WI 56 STEVEN DYKSTRA Initial Cert: 11/01/1996 steven.dykstra@milwaukeecountyw Phone: (414) 57-761 11/01/015 10/1/017 Fax: (414) 57-816 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/015 10/1/017 MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: 07 901 WEST WATERTOWN PLANK ROAD MILWAUKEE, WI 56 AMY LORENZ Initial Cert: 09/01/014 Phone: (414) 57-8085 09/01/015 08/1/016 Fax: CCS REGIONAL MODEL POPULATION-BASED DHS 6 1 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, 10045 W LISBON AVENUE, MILWAUKEE, WI 1 BELL THERAPY, INC, 4065 N 5TH STREET, MILWAUKEE, WI 518 1 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 514 1 OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI 506 1 ST CHARLES YOUTH & FAMILY SERVICES, INC, 4757 N 76TH STREET, MILWAUKEE, WI 518 1 THE GUEST HOUSE OF MILWAUKEE, 116 N 1TH STREET, MILWAUKEE, WI 505 1 WISCONSIN COMMUNITY SERVICES, 7 W WISCONSIN AVE. SUITE 00, MILWAUKEE, WI 508 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 09/01/018 08/1/016 MILWAUKEE HEALTH SERVICES, INC. DBA BEHAVIORAL HEALTH SERVICES CENTER Lic #: 164 800 W SILVER SPRING DRIVE MILWAUKEE, WI 518 Surveyor: Merrilee Follensbee DR. TITO IZARD. Initial Cert: 05/01/1994 tizard@mhis.org Phone: (414) 760-900 05/01/015 04/0/017 Fax: (414) 7-789 05/01/015 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

MILWAUKEE MENTAL HEALTH ASSOCIATES COMMUNITY SUPPORT PROGRAM Lic #: 1645 4957 W FOND DU LAC AVENUE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee ARTHUR NOBLE Initial Cert: 0/18/1997 art.noble@mmhabh.org Phone: (414) 87-1960 08/01/015 07/1/017 Fax: (414) 87-4990 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 mindstarcounseling@yahoo.com Phone: (414) 45-1115 1/01/014 11/0/016 Fax: (414) 45-054 1/01/014 11/0/016 MULTI-CULTURAL COUNSELING SERVICES II INC, DBA RENEW COUNSELING SERVICES Lic #: 01 6815 W CAPITOL DR SUITE #105 MILWAUKEE, WI 504 WAYNE CROATT Initial Cert: 1/01/01 renewcounseling1@sbcglobal.net Phone: (414) 8-4455 1/01/014 11/0/016 Fax: (414) 77-870 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 leola_wllms@newchoicesllc.net Phone: (414) 444-8445 10/01/015 09/0/017 Fax: (414) 444-84 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 Page 99 of 186

NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY, INC. Lic #: 068 144 N FARWELL, SUITE 00 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THERESA ANTHONY Initial Cert: 1/01/014 tanthony11@aol.com Phone: (414) 15-8477 1/01/014 11/0/015 Fax: (866) 440-0779 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 tripp-barbara@sbcglobal.net Phone: (414) 1-8910 04/01/015 0/1/017 Fax: (414) 455-9 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/017 04/01/015 0/1/017 OUTREACH COMMUNITY HEALTH CENTER INC RECOVERY CSP Lic #: 1777 711 W CAPITOL DRIVE MILWAUKEE, WI 506 LIZ GABRIEL Initial Cert: 07/17/1996 lizg@orchc-milw.org Phone: (414) 74-400 07/01/015 06/0/017 Fax: (414) 74-7917 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 angelas@orchc-milw.org Phone: (414) 74-400 08/01/014 07/1/016 Fax: (414) 77-61 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI 506 08/01/014 07/1/016 11/4/015 age 100 of 186

PARADIGM ENRICHMENT SERVICES, INC. 6110 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 990 FREDERICK G. JACKSON, II Initial Cert: 0/5/01 fgjackson@gmail.com Phone: (414) 9-1156 0/01/015 0/8/017 Fax: (414) 9-1155 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 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 charris89@wi.rr.com Phone: (414) 771-07 04/01/015 0/1/017 Fax: (414) 771-07 04/01/015 0/1/017 PASTORAL COUNSELING SERVICE OF THE GREATER MILWAUKEE AREA Lic #: 178 85 N MAYFAIR ROAD SUITE 101 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee STEVEN FRINGER Initial Cert: 08/07/1995 pcs-counseling@wi.twcbc.com Phone: (6) 81-777 08/01/014 07/1/016 Fax: (414) 45-7080 1 PASTORAL COUNSELING SERV OF GREATER MILW, 745 MAIN STREET, RACINE, WI 540 08/01/014 07/1/016 08/01/014 07/1/016 PATHFINDERS MILWAUKEE, INC Lic #: 1910 400 N HOLTON STREET, #400 MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee CATHY ARNEY Initial Cert: 04/01/011 carney@pathfindersmke.org Phone: (414) 964-565 06/01/014 05/1/016 Fax: (414) 964-010 06/01/014 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 heatherrotolo@penfieldchildren.org Phone: (414) 45-67 10/01/015 09/0/017 Fax: (414) 44-779 10/01/015 09/0/017 11/4/015 age 101 of 186

POSITIVE OUTLOOK CLINICAL SERVICES LLC 445 NORTH 60TH STREET MILWAUKEE, WI 518 Lic #: 796 PAMELA HANSEN Initial Cert: 08/01/008 Positiveoutlook006@yahoo.com Phone: (414) 460-6995 08/01/014 07/1/016 Fax: (414) 55-5467 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP Lic #: 989 4 WEST CAPITOL DRIVE STE LL MILWAUKEE, WI 516 CARLA WILLIAMS Initial Cert: 01/16/01 cbeam99@wi.rr.com Phone: (414) 810-441 04/01/015 0/1/016 Fax: (414) 810-441 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 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 projectaccessinc@yahoo.com Phone: (414) 456-1155 0/01/015 0/8/017 Fax: (414) 456-1655 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 psycaremilwaukee@aol.com Phone: (414) 71-06/01/015 05/1/016 Fax: (414) 71-5 06/01/015 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) 84-6777 07/01/014 06/0/016 Fax: (414) 84-8001 07/01/014 06/0/016 11/4/015 age 10 of 186

RENEW COUNSELING SERVICES 15 W. MITCHELL STREET, # MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 179 WAYNE CROATT Initial Cert: 04/01/1985 renewcounseling1@sbcglobal.net Phone: (414) 8-4455 09/01/015 08/1/017 Fax: (414) 77-870 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 08/1/017 09/01/015 08/1/017 RIVERSTONE COUNSELING & CRISIS SERVICES, LLC Lic #: 101 8018 W CAPITOL DRIVE, UNIT 6 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee SARA NEWMAN Initial Cert: 10/0/015 newman.rccs@gmail.com Phone: (414) 559-8864 10/0/015 09/0/016 Fax: (414) 4-1919 10/0/015 09/0/016 SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC Lic #: 495 170 W FLORIST AVENUE #15 MILWAUKEE, WI 509 Surveyor: Merrilee Follensbee SEBASTIAN SSEMPIJJA Initial Cert: 01/14/004 sssempijja@sbcglobal.net Phone: (414) 47-0801 01/01/015 1/1/016 Fax: (414) 47-0816 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 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 #: 945 81 N 4TH STREET, #08 MILWAUKEE, WI 51 SHEILA R RAMOS Initial Cert: 06/7/011 shecar0@yahoo.com Phone: (414) 7-90 09/01/015 08/1/017 Fax: (414) 7-964 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 11/4/015 age 10 of 186

SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM Lic #: 7 4041 N. RICHARDS STREET MILWAUKEE, WI 51 ELLA DUNBAR Initial Cert: 04/9/00 edunbar@cr-sdc.org Phone: (414) 906-704 05/01/014 04/0/016 Fax: (414) 96-691 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/014 04/0/016 05/01/014 04/0/016 ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER Lic #: 1 4757 N. 76TH STREET MILWAUKEE, WI 518 GLYNIS UNDERWOOD Initial Cert: 01/01/1991 referrals@stcharlesinc.org Phone: (414) 58-415 0/01/015 01/1/017 Fax: (414) 58-5005 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 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 #: 690 900 W OKLAHOMA AVENUE MILWAUKEE, WI 515 KATE CONNELLY Initial Cert: 08/0/006 kate.connelly@aurora.org Phone: (414) 489-4094 09/01/015 08/1/017 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 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 jessicawaldron@ladlake.org Phone: (414) 466-9450 09/01/014 08/1/016 Fax: (414) 466-070 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 1 LAD LAKE, INC. DOUSMAN, W50 - S1401 WATERVILLE ROAD, DOUSMAN, WI 5118 07/8/015 08/1/016 11/4/015 age 104 of 186

THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS Lic #: 91 600 W WALNUT STREET, SUITE -R MILWAUKEE, WI 51 TODD CAMPBELL Initial Cert: 08/19/010 toddcampbell@thebridgehealthclinic Phone: (414) 81-4500 08/01/015 07/1/017 Fax: (414) 55-451 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 jpeldo@humdevctr.org Phone: (414) 449-9908 0/01/015 01/1/016 Fax: (414) 449-991 0/01/015 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 jane@thekelleyclinic.com Phone: (414) 71-99 05/01/015 04/0/017 Fax: (414) 71-199 05/01/015 04/0/017 THE POWER OF CHANGE INC BEHAVIORAL SERVICES Lic #: 944 81 N 4TH STREET SUITE 145 MILWAUKEE, WI 51 RHONDA ARMON-BENT Initial Cert: 07/01/011 rhonda.armon@gmail.com Phone: (414) 74-8787 01/01/015 1/1/016 Fax: (414) 74-8181 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 1/1/016 01/01/015 1/1/016 11/4/015 age 105 of 186

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 juan@unitedcc.org Phone: (414) 84-100 10/01/014 09/0/016 Fax: (414) 647-860 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. FRANCIS HOSPITAL Lic #: 547 7 S 16TH STREET #00 MILWAUKEE, WI 515 BARBARA JONES Initial Cert: 10/7/004 Barbara.Jones@wfhc.org Phone: (414) 89-111 11/01/015 10/1/017 Fax: (414) 89-110 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/015 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 #: 548 5000 W CHAMBERS ST #P10 MILWAUKEE, WI 510 CAROL HESS Initial Cert: 10/7/004 carol.hess@wfhc.org Phone: (414) 874-1171 11/01/015 10/1/017 Fax: (414) 874-1177 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/015 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 smaloney@phoenixcaresystems.com Phone: (414) 445-9180 08/01/014 07/1/016 Fax: (414) 57-6971 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 1 WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI 516 08/01/014 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 509 08/01/014 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

WISCONSIN COMMUNITY SERVICES OUTPATIENT MENTAL HEALTH PROGRAM Lic #: 1995 74 W WISCONSIN AVENUE MILWAUKEE, WI 508 COLLEEN DUBLINSKI Initial Cert: 06/01/1977 colleen@wiscs.org Phone: (414) 4-515 07/01/015 06/0/017 Fax: (414) 44-191 07/01/015 06/0/017 WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIALS Lic #: 1955 0 W WELLS STREET #500 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THOMAS CARROLL Initial Cert: 06/01/1986 tcarroll@wiscs.org Phone: (414) 90-0440 10/01/014 09/0/016 Fax: (414) 6-051 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/014 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 #: 199 74 W WISCONSIN AVENUE MILWAUKEE, WI 508 SUSAN COLLYARD Initial Cert: 11/01/1995 scollyard@wiscs.org Phone: (414) 4-56 11/01/014 10/1/016 Fax: (414) 4-191 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 jennabehrens@hotmail.com Phone: (6) 689-0688 1/01/014 11/0/016 Fax: (6) 4-19 1 BEHRENS PSYCHOTHERAPY SERVICES, LLC, 100 W. SIERRA LN. SUITE D, MEQUON, WI 509 1 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 #: 96 4465 N OAKLAND AVE STE 400 D SHOREWOOD, WI 511 LYNN DELAHAN Initial Cert: 0/01/01 newleaftherapiesllc@gmail.com 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

ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C. Lic #: 10 10045 W LISBON AVENUE, #1 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee KAREN DREXLER Initial Cert: 11/0/1997 kdrexler@altlig.com Phone: (414) 58-7144 1/01/015 11/0/017 Fax: (414) 58-7158 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 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 10701 WEST NORTH AVE STE #05 WAUWATOSA, WI 56 Lic #: 874 AUGUSTINA GARBA Initial Cert: 08/01/009 angelscounseling@gmail.com Phone: (414) 60-010 08/01/015 07/1/017 Fax: (414) 455-86 08/01/015 07/1/017 APPLIED THERAPIES AND WELLNESS CENTER SC Lic #: 74 10 N MAYFAIR ROAD, #05 WAUWATOSA, WI 56 Surveyor: Merrilee Follensbee TRISHA WOLLIN Initial Cert: 05/0/007 twollin@appliedtherapiesandwellnes Phone: (414) 0-1 06/01/014 05/1/016 Fax: (414) 0-14 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/014 05/1/015 06/01/014 05/1/016 AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA Lic #: 518 10 DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 0/1/004 Kate.Connelly@aurora.org Phone: (414) 454-6506 0/01/015 0/8/017 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 0/8/017 0/01/015 0/8/017 11/4/015 age 108 of 186

AURORA PSYCHIATRIC HOSPITAL INC 10 DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee Lic #: 1647 JAMIE LEWISTON Initial Cert: 09/01/1979 jamie.surfus-lewiston@aurora.org Phone: (414) 454-6600 08/01/014 07/1/016 Fax: (414) 454-6450 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 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 CHILDYNAMICS, LLC 11904 W. NORTH AVENUE, #110 WAUWATOSA, WI 56 Lic #: 199 DR ISABELLA SARDAS Initial Cert: 0/15/000 isardas@aol.com Phone: (414) 58-447 0/01/015 0/8/017 Fax: (414) 58-48 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 kyoung@familyoptions.com Phone: (414) 41-4444 11/01/015 10/1/017 Fax: (414) 41-0858 11/01/015 10/1/017 11/4/015 age 109 of 186

LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN Lic #: 1516 800 N. MAYFAIR ROAD WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee CHUCK MESECK Initial Cert: 0/01/1978 lcfs@lcfswi.org Phone: (414) 56-8 04/01/014 0/1/016 Fax: (414) 56-848 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 1 LCFS-ST JOHN LUTHERAN CHURCH, 4850 S LAKE DRIVE, CUDAHY, WI 5110 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 18 S. PARK AVENUE, NEENAH, WI 54956 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 1614 S. RD STREET, SHEBOYGAN, WI 5081 04/01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI 549 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 10 S. ONEIDA STREET, GREEN BAY, WI 540 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 60 VINCENT ST, FOND DU LAC, WI 5495 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 8 RARITAN, FITCHBURG, WI 5711 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 940 MINERAL POINT RD, JANESVILLE, WI 554 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 00 BROADWAY DRIVE, SUN PRAIRIE, WI 5590 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4 S. ANDREWS STREET, SHAWANO, WI 5416 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 45 NORTH PINE ST, REEDSBURG, WI 5959 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 701 WASHINGTON ST, GRAFTON, WI 504 04/01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI 5014 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 70 JACKSON AVENUE, OMRO, WI 5496 04/01/015 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG STREET, PORTAGE, WI 590 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E51 CHURCH ROAD, ALGOMA, WI 5401 04/01/014 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 drtroast@wi.rr.com Phone: (414) 771-904 1/01/014 11/0/016 Fax: (414) 771-954 1/01/014 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 #: 805 00 N MAYFAIR ROAD, #45 WAUWATOSA, WI 56 DAVID DRAJKOWSKI Initial Cert: 09/09/008 ddrajkowski@pathwayclinic.com Phone: (414) 77-4455 10/01/015 09/0/017 Fax: (414) 77-4690 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 110 of 186

TOTTY AND ASSOCIATES 751 W NORTH AVENUE WAUWATOSA, WI 51 Lic #: 866 CYNTHIA TOTTY-HEFLEY Initial Cert: 06/01/009 ctotty@sbcglobal.net Phone: (414) 58-6000 06/01/014 05/1/016 Fax: (414) 58-700 06/01/014 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 westgroveclinic@yahoo.com Phone: (414) 810-4844 07/01/014 06/0/016 Fax: (414) 810-4845 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 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 5045 1/19/014 04/19/015 AURORA BEHAVIORAL HEALTH CENTER - WEST ALLIS Lic #: 97 44 S 90TH STREET SUITE 50 WEST ALLIS, WI 57 KATE CONNELLY Initial Cert: 07/1/00 kate.connelly@aurora.org Phone: (414) 454-6506 05/01/015 04/0/017 Fax: (414) 454-6450 05/01/015 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) 510-4447 04/01/015 0/1/016 Fax: 04/01/015 0/1/016 NEW BEGINNINGS MENTAL HEALTH CLINIC, LLC Lic #: 048 6754 W BELOIT RD WEST ALLIS, WI 519 RUTH KOHNKE Initial Cert: 08/05/014 nbmhcllc@gmail.com Phone: (414) 9-467 08/05/014 07/1/015 Fax: (414) 9-0606 08/05/014 07/1/015 11/4/015 Page 111 of 186

ROGERS MEMORIAL HOSPITAL 448 SOUTH 10ND ST RM #00 WEST ALLIS, WI 57 Lic #: 0 KEITH MOREHOUSE Initial Cert: 05/01/014 kmorehouse@rogershospital.org Phone: (414) 59-000 05/01/014 04/0/016 Fax: (414) 88-78 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 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 05/01/014 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 11101 W. LINCOLN AVENUE WEST ALLIS, WI 57 Surveyor: Merrilee Follensbee Lic #: 14 CATHERINE HENRICKS Initial Cert: 05/01/000 chenricks@rogershospital.org Phone: (414) 7-000 05/01/014 04/0/016 Fax: (414) 7-6045 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 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 STRESS MANAGEMENT AND MENTAL HEALTH CLINICS Lic #: 1885 1001 W LINCOLN AVENUE, #08 WEST ALLIS, WI 57 CRAIG MODELL Initial Cert: 06/01/1980 stressmang@hotmail.com Phone: (414) 9-7000 06/01/015 05/1/017 Fax: (414) 9-7010 06/01/015 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

Monroe County SCENIC BLUFFS COMMUNITY HEALTH CENTERS Lic #: 804 8 FRONT STREET CASHTON, WI 54619 Monroe County Surveyor: Roderic Senn JESSICA MLSNA Initial Cert: 07/8/008 Phone: (608) 654-5100 07/01/014 06/0/016 Fax: (608) 654-510 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 MONROE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 1654 1401 HWY B, COMM SVS CTR A-19 SPARTA, WI 54656 Monroe County Surveyor: Roderic Senn TRACY THORSEN Initial Cert: 10/01/1975 Phone: (608) 69-8600 1/01/014 11/0/016 Fax: (608) 69-895 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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

Oconto County NORTHERN HEALTH CENTERS INC. NICOLET MEDICAL & DENTAL CLINIC Lic #: 878 1597 HIGHWAY LAKEWOOD, WI 5418 Oconto County JODI MARSH Initial Cert: 07/4/009 jodim@nhcmedden.com Phone: (715) 76-61 08/01/014 07/1/016 Fax: (715) 76-148 08/01/014 07/1/016 1 NORTHERN HEALTH CENTERS, INC - WHITE LAKE CLINIC, 54 BISSEL STREET, WHITE LAKE, WI 5449 09/0/014 07/1/016 WABENO ELEMENTARY SCHOOL, 446 MILL LANE, WABENO, WI 54566 09/0/014 07/1/016 BELLIN PSYCHIATRIC CENTER OCONTO HOSPITAL & MEDICAL CENTER Lic #: 759 80 ARBUTUS AVENUE OCONTO, WI 5415 Oconto County STEVE DUSCHER Initial Cert: 10//007 sldusc@bellin. org Phone: (90) 41-5687 11/01/014 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 5414 11/01/014 10/1/016 OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 1719 501 PARK AVENUE OCONTO, WI 5415 Oconto County BRUCE RETZLAFF Initial Cert: 04/01/1979 bruce.retzlaff@co.oconto.wi.us Phone: (90) 84-7000 09/01/014 08/1/016 Fax: (90) 84-6889 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 5414 09/01/014 08/1/016 11/4/015 age 114 of 186

Oneida County MARSHFIELD CLINIC MINOCQUA COUNSELING CENTER Lic #: 157 9601 TOWNLINE ROAD MINOCQUA, WI 54548 Oneida County Surveyor: Polly Wong KAREN SWARTZ Initial Cert: 11/01/1999 karen.swartz@marshfieldclinic.org Phone: (715) 56-179 04/1/015 10/1/016 Fax: (715) 58-786 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 5455 04/1/015 10/1/016 NORTH CENTRAL COUNSELING SERVICES JOSEPH ROE & ASSOC /DBA SHIRLEY LIMBERG Lic #: 16 8618 HIGHWAY 51 NORTH MINOCQUA, WI 54548 Oneida County Surveyor: Polly Wong SHIRLEY LIMBERG Initial Cert: 0/01/000 slimberg150@charter.net Phone: (715) 56-6146 04/01/014 0/1/016 Fax: (715) 58-9556 04/01/014 0/1/016 1 NCCS J ROE & ASSOC DBA SHIRLEY LIMBERG, HIGHWAY 1 - SOUTH, PARK FALLS, WI 5455 04/01/014 0/1/016 CORNERSTONE PSYCHOLOGICAL ASSOCIATES, LLC Lic #: 977 15 S ONEIDA AVE SUITE 101 RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong THOMAS F. MCGUIRE, LPC Initial Cert: 08/14/01 cornerstoneassociatesllc@gmail.com Phone: (715) 40-101 10/01/015 09/0/017 Fax: (715) 40-10 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 115 of 186

OPTIONS COUNSELING SERVICES, LLC 158 SOUTH ANDERSON STREET, SUITE 1 RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 74 BRUCE DECORAH Initial Cert: 04/17/007 bdecorah@optionscs.net Phone: (715) 6-5745 11//015 0/1/016 Fax: (715) 6-819 CSAS-OUTPATIENT TREATMENT DHS 75.1 11//015 0/1/016 11//015 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 7 EAST WALL STREET, EAGLE RIVER, WI 5451 11//015 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 944 COUNTY RD J, PO BOX 7, MINOCQUA, WI 54548 11//015 0/1/016 OPTIONS COUNSELING SERVICES LLC, 1991 WINNEBAGO STREET, RHINELANDER, WI 54501 ANTIGO HIGH SCHOOL, 1900 TENTH AVENUE, ANTIGO, WI 54409 ANTIGO MIDDLE SCHOOL, 815 SEVENTH AVENUE, ANTIGO, WI 54409 ARBOR VITAE-WOODRUFF ELEMENTARY SCHOOL, 11065 OLD STATE HWY 51 NORTH, ARBOR VITAE, CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI 54501 CRANDON ELEMENTARY/ MIDDLE/HIGH SCHOOL, 9750 US HWY 8 WEST, CRANDON, WI 5450 CRESCENT ELEMENTARY, 19 BOYCE DRIVE, RHINELANDER, WI 54501 CRESTWOOD ELEMENTARY SCHOOL, W8464 CH AA, ANTIGO, WI 54409 EAGLE RIVER ELEMENTARY SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 EAST ELEMENTARY SCHOOL, 0 SEVENTH AVENUE, ANTIGO, WI 54409 JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI 54501 LAKELAND UNION HIGH SCHOOL DISTRICT, 957 STATE HIGHWAY 70, MINOCQUA, WI 54548 LAND O' LAKES ELEMENTARY, 6485 TOWN HALL ROAD, LAND O LAKES, WI 54540 MATTOON ELEMENTARY SCHOOL, 507 STONE AVENUE, MATTOON, WI 54450 NORTH ELEMENTARY SCHOOL, 506 GRAHAM AVENUE, ANTIGO, WI 54409 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 54501 PLEASANT VIEW ELEMENTARY SCHOOL, W11141 CTY RD HH, ANTIGO, WI 54409 RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI 54501 SOAR CHARTER SCHOOL, 6485 TOWN HALL RD, LAND O LAKES, WI 54540 SPRING VALLEY ELEMENTARY, N4754 CTH BB, ANTIGO, WI 54409 ST GERMAIN ELEMENTARY SCHOOL, 84 HWY 70 WEST, SAINT GERMAIN, WI 54558 SUGAR CAMP ELEMENTARY, 4066 CAMP FOUR RD., RHINELANDER, WI 54501 THREE LAKES ELM/JUNIOR & SENIOR HIGH SCHOOL, 690 WEST SCHOOL ST, THREE LAKES, WI 545 WEST ELEMENTARY, 1 SEVENTH AVENUE, ANTIGO, WI 54409 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 11//015 0/1/016 PRICE-DECKER CLINIC, LLC 48 W KING STREET RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 51 TERRY PRICE-DECKER Initial Cert: 07/01/004 tpdclinic@tpdclinic.com Phone: (715) 6-547 09/01/014 08/1/016 Fax: (715) 6-014 09/01/014 08/1/016 11/4/015 age 116 of 186

ST. MARY'S HOSPITAL MINISTRY BEHAVIORAL HEALTH INPATIENT Lic #: 515 51 N. SHORE DRIVE, #100 RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 05/01/004 andrea.stefonek@ministryheatlh.org Phone: (715) 61-00 05/01/014 04/0/016 Fax: (715) 61-01 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 05/01/014 04/0/016 05/01/014 04/0/016 ST. MARY'S HOSPITAL MINISTRY KOLLER BEHAVIORAL HEALTH Lic #: 176 100 KABEL AVENUE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 06/01/1985 andrea.stefonek@ministryhealth.org Phone: (715) 61-805 06/01/014 05/1/016 Fax: (715) 61-90 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/014 05/1/016 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI 5450 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 90 E WALL STREET, EAGLE RIVER, WI 5451 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI 54487 06/01/014 05/1/016 ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 11 ELM STREET, WOODRUFF, WI 54568 06/01/014 05/1/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 147 DONNA SHIMECK Initial Cert: 09/01/1980 ds@thehumanservicecenter.org Phone: (715) 69-15 10/01/015 09/0/016 Fax: (715) 69-14 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 54501 Oneida County Surveyor: Polly Wong Lic #: 04 DONNA SHIMECK Initial Cert: 06/7/014 Phone: (715) 69-15 07/01/015 06/0/017 Fax: (715) 69-14 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

THE HUMAN SERVICE CENTER CSP 705 E. TIMBER DRIVE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 146 DONNA SHIMECK Initial Cert: 09/01/1980 ds@thehumanservicecenter.org Phone: (715) 69-15 06/01/014 05/1/016 Fax: (715) 69-14 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 54501 Oneida County Surveyor: Polly Wong Lic #: 64 RICHARD MARTIN Initial Cert: 0/01/006 transitionscenter@frontiernet.net Phone: (715) 65-6696 0/01/015 01/1/017 Fax: (715) 65-6768 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 01/1/017 0/01/015 01/1/017 11/4/015 age 118 of 186

Outagamie County AFFINITY MEDICAL GROUP BEHAVIORAL HEALTH Lic #: 651 151 S MADISON ST #580 APPLETON, WI 54915 Outagamie County NADINE DUNCAN Initial Cert: 01/0/005 nduncan@affinityhealth.org Phone: (90) 78-519 11/01/015 10/1/017 Fax: (90) 70-494 11/01/015 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 5410 11/01/015 10/1/017 AFFINITY MEDICAL GROUP, 1501 SOUTH MADISON ST, APPLETON, WI 54915 AFFINITY MEDICAL GROUP, 9 N, RICHMOND ST, APPLETON, WI 54911 AFFINITY MEDICAL GROUP-BEHAVIORAL HEALTH, 1855 S KOELLER, OSHKOSH, WI 5490 AFFINITY MEDICAL GROUP-BEHAVIORAL HEALTH, 00 PATRIOT DRIVE, LITTLE CHUTE, WI 54140 11/01/015 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 Greg.Blume@catalpahealth.org Phone: (90) 750-7000 07/1/015 06/0/016 Fax: (90) 88-585 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 07/1/015 06/0/016 11/4/015 age 119 of 186

CATALPA HEALTH, INC. 444 NORTH WESTHILL BLVD APPLETON, WI 54914 Outagamie County Lic #: 984 GREG BLUME Initial Cert: 11/01/01 greg.blume@catalpahealth.org Phone: (90) 750-7000 11/01/015 10/1/017 Fax: (90) 88-5495 CSAS-PREVENTION DHS 75.04 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 54901 07/01/016 10/1/017 1 CATALPA HEALTH - CASALOMA CAMPUS, 190 N CASALOMA ST, APPLETON, WI 5491 11/01/015 10/1/017 CATALPA HEALTH ACCESS CENTER, 44 WESTHILL BLVD., APPLETON, WI 54914 CATALPA HEALTH, 181 WITZEL AVE, OSHKOSH, WI 5490 BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 08 EAST BURDICK ST, BLACK CREEK, WI 54106 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 54915 HORTONVILLE ELEMENTARY SCHOOL, 40 WARNER ST., HORTONVILLE, WI 54944 HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 0, HORTONVILLE, WI 54944 HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST; PO BOX 59, HORTONVILLE, WI 54944 MADISON MIDDLE SCHOOL, 00 S. CARPENTER STREET, APPLETON, WI 54915 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 54901 ROCKLEDGE PRIMARY/INTERMEDIATE CENTERS, 0 WEST HICKORY ST, SEYMOUR, WI 54165 ROOSEVELT MIDDLE SCHOOL, 18 EAST BREWSTER ST, APPLETON, WI 54911 SEYMOUR MIDDLE & HIGH SCHOOLS, 10 CIRCLE DRIVE, SEYMOUR, WI 54165 SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI 54170 WASHINGTON ELEMENTARY SCHOOL, 99 WINNEBAGO AVE, OSHKOSH, WI 54901 WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI 54901 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 11/01/015 10/1/017 CATHOLIC CHARITIES DIOCESE OF GREEN BAY, INC. Lic #: 118 14 E. SUMMER STREET APPLETON, WI 54911 Outagamie County CELIA J. LATOUR Initial Cert: 01/6/1988 clatour@gbdoic.org Phone: (90) 7-84 0/01/014 01/1/016 Fax: (90) 47-4067 0/01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 6 BROAD ST, #00, OSHKOSH, WI 54901 0/01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, 64 S CAMBRIDGE STREET, WAUTOMA, WI 5498 0/01/014 01/1/016 1 CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC, N845 SHADOW RD, WAUPACA, WI 54981 0/01/014 01/1/016 11/4/015 age 10 of 186

LUTHERAN SOCIAL SERVICES 00 B NORTH RICHMOND ST APPLETON, WI 54911 Outagamie County Lic #: 87 REBECKA HELDT Initial Cert: 06/0/009 rebecka.heldt@lsswis.org Phone: (90) 70-10 09/01/015 08/1/016 Fax: (90) 74-84 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 5490 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 115 NORTH 6TH STREET, WAUSAU, WI 5440 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1500 DOUGLAS DRIVE, PLYMOUTH, WI 507 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1777 WEST MAIN STREET STE 1, SUN PRAIRIE, WI 5590 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 445 PARK AVENUE, BELOIT, WI 5511 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 706 N 9TH STREET, SHEBOYGAN, WI 5081 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 74 SOUTH MAIN ST #10, FOND DU LAC, WI 5495 09/01/015 08/1/016 LUTHERAN SOCIAL SERVICES, 81 N GRANDVIEW BLVD #09, PEWAUKEE, WI 507 LUTHERAN SOCIAL SERVICES, NORTH 5TH STREET EAST, SUPERIOR, WI 54880 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 54914 APPLETON EAST HIGH SCHOOL, 11 NORTH EMMERS DRIVE, APPLETON, WI 54915 APPLETON WEST HIGH SCHOOL, 610 NORTH BADGER AVE, APPLETON, WI 54914 CLOVIS GROVE ELEMENTARY SCHOOL, 974-9TH STREET, MENASHA, WI 5495 LINCOLN ELEMENTARY SCHOOL, 1000 NORTH MASON ST, APPLETON, WI 54914 LSS - NORTHERN LIGHTS ELEMENTARY SCHOOL, 101 NORTH 8TH ST, SUPERIOR, WI 54880 LSS - SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI 54880 LSS - SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI 54880 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 54914 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 09/01/015 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 #: 14 401 S. ELM STREET APPLETON, WI 54911 Outagamie County ROSEMARY DAVIS Initial Cert: 07/01/1987 rosemary.davis@outagamie.org Phone: (90) 8-570 07/01/014 06/0/016 Fax: (90) 8-5488 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 11/4/015 age 11 of 186

OUTAGAMIE COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: 174 401 S ELM STREET APPLETON, WI 54911 Outagamie County BRIAN BEZIER, PSYD Initial Cert: 07/01/1987 brian.bezier@outagamie.org Phone: (90) 8-570 1/01/015 11/0/017 Fax: (90) 8-5488 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 #: 590 401 S ELM STREET APPLETON, WI 54911 Outagamie County JUDY VAN RYZIN Initial Cert: 04/01/005 judy.vanryzin@outagamie.org Phone: (90) 8-570 04/01/015 0/1/017 Fax: (90) 8-5488 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 ROGERS MEMORIAL HOSPITAL - APPLETON 451 W COLLEGE AVE APPLETON, WI 54914 Outagamie County Lic #: 098 DAVID DREWEK Initial Cert: 09/1/015 ddrewek@rogershospital.org Phone: (6) 646-1144 09/1/015 08/1/016 Fax: (6) 464-1049 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 09/1/015 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 54914 Outagamie County Lic #: 450 HANK SHERMAN, PH.D. Initial Cert: 06/05/00 shermanconsultingllc@yahoo.com Phone: (90) 0-065 06/01/014 05/1/016 Fax: (90) 0-6565 06/01/014 05/1/016 1 SHERMAN CONSULTING, LLC, 157 PARK PLACE SUITE 600, GREEN BAY, WI 5404 06/01/014 05/1/016 11/4/015 age 1 of 186

ST. ELIZABETH HOSPITAL 1506 S. ONEIDA STREET APPLETON, WI 54915 Outagamie County Lic #: 1860 STEVIE REICH Initial Cert: 0/01/1984 sreich@affinityhealth.org Phone: (90) 78-90 11/01/015 10/1/017 Fax: (90) 70-5480 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/015 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 54911 Outagamie County Lic #: 198 BEDFORD HINES Initial Cert: 1/01/1981 wccjeanne@yahoo.com Phone: (90) 7-199 11/01/015 10/1/017 Fax: (90) 7-1866 11/01/015 10/1/017 WI LUTHERAN CHILD & FAMILY SERVICE, INC. D/B/A CHRISTIAN FAMILY COUNSELING Lic #: 1997 1049 N LYNNDALE DRIVE, #1B APPLETON, WI 54914 Outagamie County DR MYLES TONNACLIFF Initial Cert: 05/01/1990 mtonnacliff@wlcfs.org Phone: (6) 45-555 09/01/014 08/1/016 Fax: (6) 45-551 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 5495 04/7/015 08/1/016 1 WLCFS INC - CHRISTIAN FAMILY COUNSELING, 757 S MAIN STREET, FOND DU LAC, WI 5495 09/01/014 08/1/016 MEDICAL AND COUNSELING ASSOCIATES N567 MAYFLOWER RD SHIOCTON, WI 54170 Outagamie County Lic #: 1578 JOAN HUTCHISON Initial Cert: 01/01/1986 jhutchison@chapsacademy.org Phone: (90) 986-00 0/01/015 01/1/017 Fax: (90) 986-004 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 5410 0/01/015 01/1/017 MEDICAL AND COUNSELING ASSOCIATES, 00 N WOODS EDGE DR, APPLETON, WI 54914 0/01/015 01/1/017 11/4/015 age 1 of 186

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 joymyersnsc@yahoo.com Phone: (6) 75-1116 08/01/015 07/1/017 Fax: (6) 75-1071 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 5090 08/01/015 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 info@alarushealthcare.com Phone: (6) 77-676 10/01/014 09/0/016 Fax: (6) 77-689 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 10/01/014 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 5095 04/06/015 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 AALTEAM@aol.com Phone: (6) 41-5099 06/01/015 05/1/017 Fax: (6) 41-5054 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/015 05/1/017 06/01/015 05/1/017 11/4/015 age 14 of 186

AMERICAN BEHAVIORAL CLINICS 140 W RANCHITO LANE MEQUON, WI 509 Ozaukee County Lic #: 68 JAY SCHRINSKY Initial Cert: 05/01/00 jhschrinsky@gmail.com Phone: (6) 41-1 07/01/014 05/1/016 Fax: (6) 41-411 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 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 #: 507 1111 N PORT WASHINGTON ROAD MEQUON, WI 5097 Ozaukee County WILLIAM FRY Initial Cert: 09/0/00 wfry@columbia-stmarys.org Phone: (6) 41-617 0/01/014 0/9/016 Fax: (6) 41-61 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 0/01/014 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 #: 187 1111 N PORT WASHINGTON RD MEQUON, WI 5097 Ozaukee County BILL FRY Initial Cert: 09/01/1984 wfry@columbia-stmarys.org Phone: (6) 4-788 0/01/014 0/9/016 Fax: (6) 4-880 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/014 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 northshorecenter@sbcglobal.net Phone: (6) 41-5955 0/01/015 0/8/017 Fax: (6) 41-596 0/01/015 0/8/017 11/4/015 age 15 of 186

DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY Lic #: 176 11 W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 ldake@co.ozaukee.wi.us Phone: (6) 8-8145 10/01/014 09/0/016 Fax: (6) 8-8104 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5074 08/10/016 09/0/016 DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY CSP Lic #: 74 11 W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 ldrake@co.ozaukee.wi.us Phone: (6) 8-800 04/01/015 0/1/017 Fax: (6) 8-8104 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 ldrake@co.ozaukee.wi.us Phone: (6) 84-800 10/01/015 09/0/016 Fax: (6) 84-8104 CCS REGIONAL MODEL SHARED SERVICES DHS 6 10/01/015 09/0/016 11/4/015 age 16 of 186

Pierce County PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 177 41 W KINNE STREET ELLSWORTH, WI 54011 Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 1/01/1981 ron.kiesler@co.pierce.wi.us Phone: (715) 7-6770 04/01/015 0/1/017 Fax: (715) 7-686 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/015 0/1/017 04/01/015 0/1/017 PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES/NORTHWEST CONNECTION Lic #: 96 41 W. KINNE STREET ELLSWORTH, WI 54011 Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 11/01/011 ron.kiesler@co.pierce.wi.us Phone: (715) 7-6766 04/01/015 0/1/017 Fax: (715) 7-686 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 04/01/015 0/1/017 PIERCE COUNTY DEPT OF HUMAN SVS 41 WEST KINNE STREET ELLSWORTH, WI 54011 Pierce County Surveyor: Roderic Senn Lic #: 00 RON KIESLER Initial Cert: 04/01/014 ron.kiesler@co.pierce.wi.us Phone: (715) 7-6766 04/01/015 0/1/017 Fax: (715) 7-686 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 04/01/015 0/1/017 11/4/015 age 17 of 186

Polk County AMERY REGIONAL MEDICAL CENTER BEHAVIORAL HEALTH CENTER Lic #: 89 0 DERONDA STREET AMERY, WI 54001 Polk County Surveyor: Polly Wong HEATHER ERICKSON Initial Cert: 1/08/008 Heather.E.Erickson@Amerymedical Phone: (715) 68-0060 1/01/015 11/0/017 Fax: (715) 68-0061 MENTAL HEALTH-INPATIENT DHS 61.71 1/01/015 11/0/017 1/01/015 11/0/017 1 LUCK CLINIC, AMERY HOSPITAL AND CLINIC, 17 FIRST AVENUE, LUCK, WI 5485 1/01/015 11/0/017 NORTHWEST JOURNEY - AMERY 1096 APPLE AVENUE AMERY, WI 54001 Polk County Surveyor: Polly Wong Lic #: 195 AMY WALLIN Initial Cert: 0/14/000 amyw@nwcgc.com Phone: (715) 68-5404 0/01/014 01/1/016 Fax: (715) 68-610 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 #50-101 150TH ST BALSAM LAKE, WI 54810 Polk County Surveyor: Polly Wong KRISTIN BOLAND Initial Cert: 01/6/000 kristin.boland@co.polk.wi.us Phone: (715) 485-8400 05/01/014 04/0/016 Fax: (715) 485-8450 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/014 04/0/016 POLK COUNTY MENTAL AND BEHAVIORAL HEALTH SERVICES Lic #: 04 100 POLK COUNTY PLAZA #50 BALSAM LAKE, WI 54810 Polk County Surveyor: Polly Wong KRISTIN BOLAND Initial Cert: 0/08/000 kristin.boland@co.polk.wi.us Phone: (715) 485-8400 05/01/014 04/0/016 Fax: (715) 485-8490 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

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 ellenr@nwpltd.org Phone: (715) 7-440 0/01/014 01/1/016 Fax: (715) 7-4470 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 54801 0/01/014 01/1/016 NORTHWEST PASSAGE 1, 7818 MOLINE RD, PO BOX 49, WEBSTER, WI 5489 0/01/014 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 peacetree@centurytel.net Phone: (715) 755-06/01/015 05/1/017 Fax: (715) 755-966 06/01/015 05/1/017 11/4/015 age 19 of 186

Portage County OSWALD COUNSELING ASSOCIATES 450 VINEYARD DRIVE PLOVER, WI 54467 Portage County Lic #: 566 LYNNE OSWALD Initial Cert: 01/14/005 ocainc@sbcglobal.net Phone: (715) 4-090 01/01/014 1/1/015 Fax: (715) 4-091 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/014 1/1/015 01/01/014 1/1/015 ACS CLINICAL SERVICES, LLC - STEVENS POINT Lic #: 87 1547 STRONGS AVE STE STEVENS POINT, WI 54481 Portage County MARK ROSSANO Initial Cert: 09/15/009 mrossano@acsclinicalservices.org Phone: (715) 95-9618 08/01/015 09/0/016 Fax: (715) 95-961 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 09/0/016 08/01/015 09/0/016 1 ACS CLINICAL SERVICES LLC - SPARTA, 101 SOUTH WATER STREET, SPARTA, WI 54656 08/01/015 09/0/016 1 ACS CLINICAL SERVICES, LLC - WAUSAU, 90 ND STREET, WAUSAU, WI 5440 08/01/015 09/0/016 ADVOCATE PSYCHOTHERAPY SERVICES, LLC 900 HOOVER AVE, SUITE B STEVENS POINT, WI 54481 Portage County Lic #: 051 STEVEN JOHNSON Initial Cert: 10/01/014 office@advocatepsychotherapyserv Phone: (800) 681-74 10/01/015 09/0/016 Fax: (715) 95-4995 1 ADVOCATE PSYCHOTHERAPY SERVICES, LLC, 146 N. CENTRAL AVE., STE. 04, MARSHFIELD, WI 544 10/01/015 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 54495 10/01/015 09/0/016 10/01/015 09/0/016 MINISTRY BEHAVIORAL HEALTH 09 PRENTICE STREET NORTH STEVENS POINT, WI 54481 Portage County Lic #: 117 LAURIE ROBERTS Initial Cert: 05/01/1991 laurie.roberts@ministryhealth.org Phone: (715) 44-4611 07/01/015 06/0/017 Fax: (715) 44-817 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 10 of 186

MINISTRY MEDICAL GROUP-PSYCHIATRY DEPARTMENT Lic #: 1796 98 E MARIA DRIVE STEVENS POINT, WI 54481 Portage County LINDA MASSOPUST Initial Cert: 1/01/198 linda.massopust@ministryhealth.org Phone: (715) 41-7441 01/01/014 1/1/015 Fax: (715) 41-9178 01/01/014 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 54481 WASHINGTON ELEMENTARY, 500 PRAIS STREET, STEVENS POINT, WI 54481 09/15/015 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 diane@newdirectionscc.com Phone: (715) 45-9690 06/01/014 05/1/016 Fax: (715) 45-98 06/01/014 05/1/016 1 NEW DIRECTIONS COUNSELING CENTER, 1106-4TH AVENUE, WOODRUFF, WI 54568 06/01/014 05/1/016 1 NEW DIRECTIONS COUNSELING CENTER, N919 COUNTY RD QQ, WAUPACA, WI 54981 06/01/014 05/1/016 BENJAMIN FRANLKLIN JUNIOR HIGH SCHOOL, 000 POLK ST., STEVENS POINT, WI 54481 PJ JACOBS JUNIOR HIGH SCHOOL, 400 MAIN ST, STEVENS POINT, WI 54481 PLOVER-WHITING ELEMENTARY SCHOOL, 1400 HOOVER AVENUE, PLOVER, WI 54467 ROOSEVELT IDEA ELEMENTARY SCHOOL, 00 WISCONSIN AVE., PLOVER, WI 54467 STEVENS POINT AREA SENIOR HIGH SCHOOL, 101 NORTH POINT DR., STEVENS POINT, WI 54481 0/06/015 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 54481 Portage County Lic #: 405 LAURA KOWALSKI Initial Cert: 10/14/00 nwjstevenspoint@nwcgc.com Phone: (715) 4-8065 0/01/015 01/1/017 Fax: (715) 4-807 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 #: 1740 817 WHITING AVENUE STEVENS POINT, WI 54481 Portage County AMY MARCOTT Initial Cert: 06/01/1976 marcotta@co.portage.wi.us Phone: (715) 45-5810 04/01/015 0/1/017 Fax: (715) 45-5966 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

PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 71 817 WHITING AVENUE STEVENS POINT, WI 54481 Portage County AMY MARCOTT Initial Cert: 0/01/007 marcotta@co.portage.wi.us Phone: (715) 45-5810 0/01/015 0/8/017 Fax: (715) 45-5966 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 RIVERWOOD COUNSELING ASSOCIATES LLC 105 MAIN STREET, #0 STEVENS POINT, WI 54481 Portage County Lic #: 0 ROBERT A MILLER Initial Cert: 07/17/000 riverwood_counseling@hotmail.com Phone: (715) 4-556 07/01/014 06/0/016 Fax: (715) 4-5899 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 SAINT MICHAEL'S HOSPITAL 900 ILLINOIS AVENUE STEVENS POINT, WI 54481 Portage County Lic #: 180 LAURIE ROBERTS Initial Cert: 05/01/1978 laurie.roberts@ministryhealth.org Phone: (715) 46-5400 10/01/015 09/0/017 Fax: (715) 46-5571 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/015 09/0/017 10/01/015 09/0/017 11/4/015 age 1 of 186

Price County COMMUNITY SUPPORT CENTER OF PRICE COUNTY Lic #: 11 548 N. LAKE AVENUE PHILLIPS, WI 54555 Price County Surveyor: Polly Wong PAM OLSON Initial Cert: 04/01/1998 commsupp@pctcnet.net Phone: (715) 9-6449 01/01/014 1/1/015 Fax: (715) 9-6450 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 01/01/014 1/1/015 COUNSELING AND DEVELOPMENT CENTER, INC. Lic #: 144 171 CHESTNUT STREET PHILLIPS, WI 54555 Price County Surveyor: Polly Wong KELLY J. SCHULTZ Initial Cert: 08/01/198 cdcinc@pctcnet.net Phone: (715) 9-048 08/01/015 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 5455 08/01/015 07/1/017 COUNSELING AND DEVELOPMENT CENTER, INC. COMMUNITY SUPPORT PROGRAM Lic #: 05 171 CHESTNUT STREET PHILLIPS, WI 54555 Price County Surveyor: Polly Wong MR. KELLY SCHULTZ Initial Cert: 08/01/1998 cdcinc@pctcnet.net Phone: (715) 9-048 11/01/015 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 #: 644 104 S EYDER PHILLIPS, WI 54555 Price County Surveyor: Polly Wong MARILYN SCHREUDER Initial Cert: 0/01/006 marilyn.schreuder@co.price.wi.us Phone: (715) 9-158 0/01/015 01/1/017 Fax: (715) 9-4018 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 01/1/017 11/4/015 age 1 of 186

SAFE HAVEN COUNSELING 548 N LAKE AVENUE PHILLIPS, WI 54555 Price County Surveyor: Polly Wong Lic #: 79 PAMELA OLSON Initial Cert: 05/01/008 safehaven@pctcnet.net Phone: (715) 9-645 05/01/015 04/0/016 Fax: (715) 9-6450 05/01/015 04/0/016 11/4/015 age 14 of 186

Racine County AURORA MEDICAL GROUP BEHAVIORAL HEALTH SERVICES Lic #: 1089 190 GARDNER AVENUE, # BURLINGTON, WI 5105 Racine County Surveyor: William Rohner KATE CONNELLY Initial Cert: 10/01/198 kateconnelly@aurora.org Phone: (6) 76-7766 0/01/015 01/1/017 Fax: (6) 76-96 0/01/015 01/1/017 1 AURORA MED GROUP BEHAV HLTH-WATERFORD, 818 FORREST, WATERFORD, WI 5185 0/01/015 01/1/017 CLINICAL PSYCHOLOGY ASSOCIATES OF BURLINGTON Lic #: 106 45 MILWAUKEE AVENUE BURLINGTON, WI 5105 Racine County Surveyor: William Rohner DAVID W THOMPSON PHD Initial Cert: 0/01/199 dthompson@clinicpsych.com Phone: (6) 76-9191 04/01/014 0/1/016 Fax: (6) 76-7767 04/01/014 0/1/016 1 CLINICAL PSYCHOLOGY ASSOC OF WATERFORD, 07B MILWAUKEE AVENUE, WATERFORD, WI 5185 04/01/014 0/1/016 PROFESSIONAL PSYCHOLOGICAL SERVICES, S.C. Lic #: 1746 441 MILWAUKEE STREET, # BURLINGTON, WI 5105 Racine County Surveyor: William Rohner DEAN STOLLDORF, PHD Initial Cert: 0/01/1991 drstolldorf@wisconsin-pps.com Phone: (6) 767-0440 0/01/014 0/9/016 Fax: (6) 767-0777 0/01/014 0/9/016 BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY Lic #: 976 1717 TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 08/0/01 michelle.goggins@goracine.org Phone: (6) 68-6744 08/01/015 07/1/017 Fax: (6) 68-6540 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 11/4/015 age 15 of 186

CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE Lic #: 115 800 WISCONSIN AVE RACINE, WI 540 Racine County Surveyor: William Rohner MANDY BIBO Initial Cert: 06/01/1981 mbibo@ccmke.org Phone: (414) 771-881 07/01/014 06/0/016 Fax: (6) 67-0695 07/01/014 06/0/016 1 CATHOLIC CHARITIES OF MILW - KENOSHA, 4 45TH ST., KENOSHA, WI 5140 07/01/014 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 gretchen.huletz@cssw.org Phone: (6) 6-591 10/01/015 09/0/017 Fax: (6) 6-619 10/01/015 09/0/017 CSSW - BURLINGTON, 480 S PINE, BURLINGTON, WI 5105 10/01/015 09/0/017 SC JOHNSON ELEMENTARY SCHOOL, 40 KENTUCKY ST, RACINE, WI 5404 WADEWITZ ELEMENTARY SCHOOL, 700 YOUT ST, RACINE, WI 5404 10/01/015 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 DeRoseFamilyCounseling@gmail.co Phone: (6) 6-15 04/01/015 0/1/017 Fax: (6) 6-16 04/01/015 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 dir@fsracine.org Phone: (6) 64-91 01/01/015 1/1/016 Fax: (6) 64-54 01/01/015 1/1/016 11/4/015 age 16 of 186

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 ceo@harvestconsult.com Phone: (6) 60-870 07/01/014 11/0/015 Fax: (6) 60-858 CSAS-AMBULATORY DETOXIFICATION DHS 75.08 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 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 hopes@hopescenter.org Phone: (6) 898-940 11/01/014 10/1/016 Fax: (6) 898-177 1 LOVE INC COMMUNITY CENTER, 480 SOUTH PINE ST, BURLINGTON, WI 5105 11/01/014 10/1/016 11/01/014 10/1/016 PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC LLC Lic #: 77 5801 WASHINGTON AVENUE, #110 RACINE, WI 5406 Racine County Surveyor: William Rohner ALICE PORTIS-PATTERSON Initial Cert: 0/05/008 pmccounseling@wi.twcbc.com Phone: (6) 884-974 0/01/015 0/8/017 Fax: (6) 884-975 0/01/015 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 bompsychservices@tds.net Phone: (6) 65-550 11/01/014 10/1/016 Fax: (6) 65-550 11/01/014 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 michelle.goggins@goracine.org Phone: (6) 68-66 06/01/015 05/1/017 Fax: (6) 68-6857 CCS REGIONAL MODEL SHARED SERVICES DHS 6 06/01/015 05/1/017 11/4/015 age 17 of 186

RACINE COUNTY HUMAN SERVICES DEPARTMENT Lic #: 490 1717 TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 01/14/004 michelle.goggins@goracine.org Phone: (6) 68-66 01/01/015 1/1/016 Fax: (6) 68-698 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 95 1717 TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 1/01/011 michelle.goggins@goracine.org Phone: (6) 68-66 1/01/014 11/0/016 Fax: (6) 68-698 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/014 11/0/016 WHEATON FRANCISCAN HEALTHCARE ALL SAINTS MENTAL HEALTH & ADDICTION CARE Lic #: 107 10 WISCONSIN AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner KAREN MOLNAR-SMITH Initial Cert: 07/01/1990 Karen.Molnar-smith@wfhc.org Phone: (6) 687-16 07/01/014 06/0/016 Fax: (6) 687-80 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 07/01/014 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 540 01/06/015 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

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 csorenson@lakeview.ws Phone: (6) 54-8565 0/01/015 01/1/017 Fax: (6) 54-855 0/01/015 01/1/017 Ramsey County (MN) FAMILY INNOVATIONS, INC 10 B&C CTY RD D EAST MAPLEWOOD, MN 55109 Ramsey County (MN) Surveyor: Roderic Senn Lic #: 90 CHERYL LERFALD Initial Cert: 05/01/01 clerfald@familyinnovations.com Phone: (651) 748-5019 04/17/015 04/0/016 Fax: (651) 77-7591 04/17/015 04/0/016 1 FAMILY INNOVATIONS, INC, 15 MAIN STREET STE 05, BALSAM LAKE, WI 54810 04/17/015 04/0/016 FAMILY INNOVATIONS, INC, 11 CARMICHAEL, HUDSON, WI 54016 FAMILY INNOVATIONS - UNITY SCHOOL, 1908-150TH STREET, BALSAM LAKE, WI 54810 04/17/015 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 shesseltine@hazeldenbettyford.org Phone: (651) 9-400 05/01/015 04/0/017 Fax: (651) 1-4551 05/01/015 04/0/017 HAZELDEN CENTER CITY, 1551 PLEASANT VALLEY RD, CENTER CITY, MN 5501 05/01/015 04/0/017 HAZELDEN PLYMOUTH, 11505 6TH AVE. N, PLYMOUTH, MN 55441 05/01/015 04/0/017 11/4/015 age 19 of 186

Richland County RICHLAND COUNTY HEALTH & HUMAN SERVICES Lic #: 1797 1 W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren MYRANDA CULVER Initial Cert: 01/01/1988 myranda.culver@co.richland.wi.us Phone: (608) 647-881 0/01/014 01/1/016 Fax: (608) 647-6611 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 myranda.culver@co.richland.wi.us Phone: (608) 647-881 01/01/014 1/1/015 Fax: (608) 647-6611 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

Rock County BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER Lic #: 1100 1969 W. HART ROAD BELOIT, WI 5511 Rock County Surveyor: William Rohner GREG AMMON Initial Cert: 07/01/1985 gammon@beloithealthsystem.org Phone: (608) 64-5686 1/01/014 11/0/016 Fax: (608) 6-5756 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 11/0/016 1/01/014 11/0/016 1 BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI 5511 1/01/014 11/0/016 1 JANESVILLE OCCUPATIONAL HEALTH, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI 5545 1/01/014 11/0/016 BELOIT MEMORIAL HIGH SCHOOL, 15 4TH STREET, BELOIT, WI 5511 1/01/014 11/0/016 FAMILY SERVICES OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INC. Lic #: 11 416 COLLEGE STREET BELOIT, WI 5511 Rock County Surveyor: William Rohner JENNIFER WEIDNER Initial Cert: 06/01/1981 Jfruin@familyservices1.org Phone: (608) 65-144 06/01/015 05/1/017 Fax: (608) 65-4097 06/01/015 05/1/017 ROCK COUNTY HUMAN SERVICES DEPARTMENT - BELOIT COMMUNITY SUPPORT PROGRAM Lic #: 1804 64 ECLIPSE CENTER BELOIT, WI 5511 Rock County Surveyor: Cynthia Lindgren AMY COTTINGTON Initial Cert: 09/01/1989 Phone: (608) 6-600 05/01/015 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 apclinic1519@gmail.com Phone: (608) 75-755 06/01/014 05/1/016 Fax: (608) 75-694 06/01/014 05/1/016 1 ASSOCIATES IN PSYCHOTHERAPY, 66 PARK AVENUE, BELOIT, WI 5511 06/01/014 05/1/016 11/4/015 age 141 of 186

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 jburns@gencounseling.com Phone: (608) 757-0404 07/01/015 06/0/016 Fax: (608) 757-19 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/015 06/0/016 07/01/015 06/0/016 MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM Lic #: 00 90 MINERAL POINT AVENUE JANESVILLE, WI 5548 Rock County Surveyor: William Rohner BELINDA WELLNITZ Initial Cert: 05/18/01 bwellnitz@mhsjvl.org Phone: (608) 756-6545 07/01/015 06/0/017 Fax: (608) 756-6564 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/015 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 lusgaard@mhsjvl.org Phone: (608) 756-6545 07/01/015 06/0/017 Fax: (608) 756-6564 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/015 06/0/017 07/01/015 06/0/017 11/4/015 age 14 of 186

MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE Lic #: 1610 90 MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 01/01/199 lusgaard@mhsjvl.org Phone: (608) 755-470 01/01/014 1/1/015 Fax: (608) 756-0174 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/014 1/1/015 01/01/014 1/1/015 1 MERCY MALL CLINIC, 1010 N WASHINGTON, JANESVILLE, WI 5545 01/01/014 1/1/015 1 MERCY CLINIC NORTH, 400 DEERFIELD DRIVE, JANESVILLE, WI 5546 01/01/014 1/1/015 1 MERCY EAST CLINIC, 54 E MILWAUKEE STREET, JANESVILLE, WI 5546 01/01/014 1/1/015 1 MERCY EDGERTON MEDICAL CENTER, 17 N MAIN ST, EDGERTON, WI 554 01/01/014 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 5190 01/01/014 1/1/015 1 MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI 5545 01/01/014 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 5191 01/01/014 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 #: 741 0 EAST COURT ST JANESVILLE, WI 5547 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 07/01/007 lusgaard@mhsjvl.org Phone: (608) 741-117 07/01/015 06/0/017 Fax: (608) 758-5761 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 #: 00 50 NORTH COUNTY HWY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATE FLANAGAN Initial Cert: 07/01/014 flanagan@co.rock.wi.us Phone: (608) 757-5566 07/01/015 06/0/016 Fax: (608) 757-5545 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 554 07/01/015 06/0/016 11/4/015 age 14 of 186

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 RCHSD@co.rock.wi.us Phone: (608) 757-5850 09/01/014 08/1/016 Fax: (608) 757-5545 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 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 5546 09/01/015 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 5511 01/7/015 08/1/016 09/01/014 08/1/016 ROCK COUNTY HUMAN SERVICES CRISIS INTERVENTION UNIT Lic #: 180 50 N COUNTY HIGHWAY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATHERINE FLANAGAN Initial Cert: 01/10/1975 RCHSD@co.rock.wi.us Phone: (608) 757-505 09/01/015 08/1/016 Fax: (608) 758-846 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/015 08/1/016 ROCK COUNTY HUMAN SERVICES DEPARTMENT - JANESVILLE COMMUNITY SUPPORT PROGRAM Lic #: 1805 11 S FRANKLIN ST JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren AMY COTTINGTON Initial Cert: 09/01/1989 Phone: (608) 757-5566 05/01/015 04/0/017 Fax: (608) 757-5545 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 aeggers@rvcp.org Phone: (608) 741-4500 0/01/014 0/9/016 Fax: (608) 741-450 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 JANESVILLE PSYCHIATRIC CLINIC, 15 W. MILWAUKEE ST., #07, JANESVILLE, WI 5546 04/5/015 0/9/016 11/4/015 age 144 of 186

TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: 165 17 S RIVER STREET #54 JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren TIM PERRY Initial Cert: 09/01/1977 tperry@crossroads7.com Phone: (608) 755-560 10/01/015 09/0/017 Fax: (608) 755-567 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 5590 10/01/015 09/0/017 Rusk County ACCESS, INC COMMUNITY SUPPORT PROGRAM Lic #: 948 108 W ND STREET N LADYSMITH, WI 54848 Rusk County Surveyor: Polly Wong ANDY WOLF Initial Cert: 09/06/011 awolf@auroraservices.com Phone: (715) 5-9771 09/01/015 08/1/017 Fax: (715) 5-9774 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 #: 691 11 E MINER AVENUE LADYSMITH, WI 54848 Rusk County Surveyor: Polly Wong JEREMY JACOBS Initial Cert: 05/16/006 jjacobs@ruskcountywi.us Phone: (715) 5-99 05/01/014 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

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 chris.babbitt@healthybaldwin.org Phone: (715) 684-6777 07/01/014 06/0/016 Fax: (715) 684-6776 07/01/014 06/0/016 1 BALDWIN AREA MED CNTR-NORTHWEST COUNSL, 50 SECOND ST #0, HUDSON, WI 54016 07/01/014 06/0/016 HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE Lic #: 117 901 DOMINION DRIVE HUDSON, WI 54016 Saint Croix County Surveyor: Roderic Senn PETER VAN DUSARTZ Initial Cert: 09/01/1990 Peter.J.Vandusartz@HudsonHospita Phone: (715) 51-6755 1/01/015 11/0/017 Fax: (715) 51-6766 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 11/0/017 1/01/015 11/0/017 1 HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI 54016 1/01/015 11/0/017 1 WESTFIELDS HOSPITAL, 55 HOSPITAL ROAD, NEW RICHMOND, WI 54017 1/01/015 11/0/017 MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: 859 910 ENLOE STREET UNIT 4 HUDSON, WI 54016 Saint Croix County Surveyor: Roderic Senn THOMAS E JOHNSTON Initial Cert: 05/01/009 mfhsec@sbcglobal.net Phone: (715) 81-547 05/01/014 04/0/016 Fax: (715) 81-548 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 54017 Saint Croix County Surveyor: Roderic Senn Lic #: 07 JAMIE MASON Initial Cert: 1/04/014 jamie@ftacounseling.com Phone: (715) 46-4840 1/04/014 11/0/015 Fax: (715) 46-4108 1/04/014 11/0/015 1 FAMILY THERAPY ASSOCIATES, LLC, 50 S WASHINGTON ST, STE 110, SAINT CROIX FALLS, WI 5404 06/15/015 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 5404 1/04/014 11/0/015 1/04/014 11/0/015 11/4/015 age 146 of 186

ST. CROIX COUNTY HEALTH & HUMAN SERVICES - BEHAVIORAL HEALTH Lic #: 1856 175 DORSET LANE NEW RICHMOND, WI 54017 Saint Croix County Surveyor: Roderic Senn KATHY HUSTON Initial Cert: 01/01/1990 kathy.huston@co.saint-croix.wi.us Phone: (715) 46-804 1/01/014 11/0/016 Fax: (715) 46-8461 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 1/01/014 11/0/016 ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH Lic #: 1855 175 DORSET LANE NEW RICHMOND, WI 54017 Saint Croix County Surveyor: Roderic Senn STEVE KIRT Initial Cert: 10/01/1975 steve.kirt@co.saint-croix.wi.us Phone: (715) 46-856 1/01/014 11/0/016 Fax: (715) 46-884 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

Saint Louis County (MN) ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER Lic #: 168 50 EAST SECOND STREET DULUTH, MN 55805 Saint Louis County (MN) Surveyor: Polly Wong DONNA CRIDER Initial Cert: 09/01/1987 donna.crider@essentiahealth.org Phone: (18) 77-876 01/01/015 11/0/016 Fax: (18) 7-07 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/015 11/0/016 01/01/015 11/0/016 ESSENTIA HEALTH DULUTH DBA SMDC MEDICAL CENTER Lic #: 08 615 PECAN AVENUE DULUTH, MN 55811 Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 10/01/1998 Thomas.Jensen@EssentiaHealth.or Phone: (18) 786-100 01/01/015 11/0/016 Fax: (18) 786-105 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 55805 Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 0/5/014 thomas.jensen@essentiahealth.org Phone: (18) 786-5990 0/01/015 01/1/016 Fax: (18) 77-758 MENTAL HEALTH-DAY TREATMENT DHS 61.75 0/01/015 01/1/016 SMDC MEDICAL CENTER DBA ESSENTIA HEALTH DULUTH CLINIC Lic #: 999 50 EAST ND STREET DULUTH, MN 55805 Saint Louis County (MN) Surveyor: Polly Wong THOMAS JENSEN Initial Cert: 0/06/01 Thomas.Jensen@EssentiaHealth.or Phone: (18) 786-910 0/01/014 0/9/016 Fax: (18) 7-07 0/01/014 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 55805 Saint Louis County (MN) Surveyor: Polly Wong Lic #: 1865 KATHLEEN FOREMAN Initial Cert: 0/01/1995 kforeman@slhduluth.com Phone: (18) 49-550 0/01/015 01/1/017 Fax: (18) 49-457 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 01/1/017 11/4/015 age 148 of 186

Sauk County INNERVISIONS COUNSELING AND CONSULTING CENTER, SC Lic #: 146 708 ELIZABETH STREET BARABOO, WI 591 Sauk County COLLEEN S. JAMES Initial Cert: 11/19/007 innervisions@centurylink.net Phone: (608) 477-9858 11/01/014 10/1/016 Fax: (877) 560-0578 11/01/014 10/1/016 1 INNERVISIONS COUNSELING & CONSULTING CENTER, 1 EAST STATE ST, MAUSTON, WI 5948 11/01/014 10/1/016 1 NECEDAH FAMILY MEDICAL CENTER, 1408 WHEELIHAN AVE, NECEDAH, WI 54646 11/01/014 10/1/016 1 NEW LISBON FAMILY MEDICAL CENTER, 901 WEST BRIDGE STREET, NEW LISBON, WI 5950 11/01/014 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 5948 10/1/016 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 #: 71 505 BROADWAY BARABOO, WI 591 Sauk County SHARON BOESL Initial Cert: 0/01/007 SBoesl@co.sauk.wi.us Phone: (608) 55-400 0/01/015 0/8/017 Fax: (608) 55-499 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 5959 0/01/015 0/8/017 SAUK COUNTY DEPARMENT OF HUMAN SERVICES Lic #: 184 505 BROADWAY STREET BARABOO, WI 591 Sauk County SHARON BOESL Initial Cert: 01/01/1988 sboesl@co.sauk.wi.us Phone: (608) 55-400 01/01/014 1/1/015 Fax: (608) 55-499 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5959 01/01/014 1/1/015 11/4/015 age 149 of 186

ST. CLARE CENTER, ST. CLARE HOSPITAL 1510 JEFFERSON STREET BARABOO, WI 591 Sauk County Lic #: 087 JUDY HANNAFORD Initial Cert: 11/5/1998 Judy_Hannaford@ssmhc.com Phone: (608) 55-1759 0/01/014 01/1/016 Fax: (608) 56-165 CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 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 tkirch@pathwayclinic.com Phone: (608) 64-66 01/01/014 1/1/015 Fax: (608) 64-5014 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 1104-1ST STREET SUITE E REEDSBURG, WI 5959 Sauk County Lic #: 774 BARBARA GOODMAN Initial Cert: 0/06/008 goodmanbehavioralhealth@yahoo.c Phone: (608) 768-4545 0/01/015 0/8/017 Fax: (608) 768-4646 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 0/8/017 0/01/015 0/8/017 SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 18 45 SIXTH STREET REEDSBURG, WI 5959 Sauk County ANGELA TOURDOT Initial Cert: 07/01/1990 atourdot@co.sauk.wi.us Phone: (608) 54-7910 07/01/014 06/0/016 Fax: (608) 54-7980 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 11/4/015 age 150 of 186

Sawyer County COUNSELING AND PSYCHOLOGICAL SERVICES LLC Lic #: 001 15655 W COUNTY HWY B HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong CONSTANCE NEWMAN Initial Cert: 04/01/01 icsconnie@gmail.com Phone: (715) 699-1500 04/01/015 0/1/017 Fax: (715) 699-150 1 CAPS - HURLEY OFFICE, 09 W. SILVER STREET, HURLEY, WI 5454 04/01/015 0/1/017 04/01/015 0/1/017 COUNSELING & PSYCHOLOGICAL SVS, 01 S ELLIS AVE, ASHLAND, WI 54806 CAPS - BUTTERNUT, 1 WEST WISCONSIN STREET, BUTTERNUT, WI 54514 CAPS - MELLEN SCHOOL DISTRICT, 40 S. MAIN ST, MELLEN, WI 54546 CAPS - NORTHWOOD SCHOOL, N1446 HWY 5, MINONG, WI 54859 04/01/015 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 #: 1486 180 W TREPANIA ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong JENNY INGRAM Initial Cert: 0/01/1987 Jingram@lcohc.com Phone: (715) 68-5115 07/01/014 06/0/016 Fax: (715) 64-6107 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHWEST OASIS, 16096 US HWY 6, HAYWARD, WI 5484 07/01/014 06/0/016 LAC COURTE OREILLES OJIBWE SCHOOL, 8575 N. TREPANIA ROAD, HAYWARD, WI 5484 07/01/014 06/0/016 NORTHLAND COMMUNITY SERVICES COMMUNITY SUPPORT PROGRAM Lic #: 0 1070 OLKER ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong CAROL LUND Initial Cert: 0/01/001 northlandcsp@centurytel.net Phone: (715) 64-5 09/01/014 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 northland006@centurytel.net Phone: (715) 64-0 04/01/014 0/1/016 Fax: (715) 64-17 1 NORTHLAND COUNSELING SERVICES LTD, 16096 US HWY 6, HAYWARD, WI 5484 04/01/014 0/1/016 04/01/014 0/1/016 11/4/015 age 151 of 186

NORTHWEST JOURNEY - HAYWARD 1609 US HIGHWAY 6 HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong Lic #: 049 ANNE WOLLAN Initial Cert: 09/16/014 annew@nwcgc.com Phone: (715) 699-141 09/01/015 08/1/017 Fax: (175) 699-14 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 #: 998 1070 OLKER ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong PAUL G. GRAHOVAC Initial Cert: 10/01/01 northland006@centurytel.net Phone: (715) 64-4806 10/01/015 09/0/016 Fax: (715) 64-5019 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/015 09/0/016 11/4/015 age 15 of 186

Shawano County STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER Lic #: 188 W180 COUNTY HWY A BOWLER, WI 54416 Shawano County NANCY MILLER-KORTH Initial Cert: 06/19/014 Phone: (715) 79-000 08/01/015 07/1/016 Fax: (715) 79-11 CSAS-OUTPATIENT TREATMENT DHS 75.1 08/01/015 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 pgauthier@mitw.org Phone: (715) 799-85 1/01/015 11/0/016 Fax: (715) 799-86 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 1/01/015 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 #: 181 504 LAKELAND ROAD SHAWANO, WI 54166 Shawano County JESSICA DELZER Initial Cert: 0/01/1977 jessica.delzer@co.shawano.wi.us Phone: (715) 54-6879 01/01/015 1/1/016 Fax: (715) 56-554 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 #: 4 504 LAKELAND ROAD SHAWANO, WI 54166 Shawano County KELLY BUESCHEL Initial Cert: 01/01/000 kelly.bueschel@co.shawano.wi.us Phone: (715) 56-5547 01/01/015 1/1/016 Fax: (715) 56-554 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

SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS Lic #: 86 504 LAKELAND ROAD SHAWANO, WI 54166 Shawano County JESSICA DELZER Initial Cert: 05/06/014 jessica.delzer@co.shawano.wi.us Phone: (715) 56-4700 07/01/015 06/0/017 Fax: (715) 56-554 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

Sheboygan County AURORA SHEBOYGAN CLINIC 414 KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 195 TRACY LEE-JOHNSON Initial Cert: 07/01/1986 tracy.lee-johnson@aurora.org Phone: (90) 459-1494 07/01/014 06/0/016 Fax: (90) 459-148 CSAS-OUTPATIENT TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 1 AURORA SHEBOYGAN CLINIC, 600 KILEY WAY, PLYMOUTH, WI 507 07/01/014 06/0/016 AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER Lic #: 185 69 N 7TH STREET SHEBOYGAN, WI 508 Sheboygan County LORI KNITT Initial Cert: 05/01/1987 lori.knitt@aurora.org Phone: (90) 451-5510 05/01/014 04/0/016 Fax: (90) 451-51 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 05/01/014 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 #: 11 50 WISCONSIN AVENUE SHEBOYGAN, WI 5081 Sheboygan County MANDY BIBO Initial Cert: 04/01/198 mbibo@ccmke.org Phone: (90) 458-576 05/01/015 04/0/017 Fax: (90) 458-586 1 CATHOLIC CHARITIES ARCHDIOCESE OF MILW INC, 191 S MAIN STREET, FOND DU LAC, WI 5495 05/01/015 04/0/017 05/01/015 04/0/017 LEPAK JOSTSONS INC DBA DYNAMIC FAMILY SOLUTIONS Lic #: 869 615 SOUTH 8TH ST SUITE 0 SHEBOYGAN, WI 5081 Sheboygan County JANE A LEPAK JOSTSONS Initial Cert: 08/19/009 jljostsons@dynamicfamilysolutions.c Phone: (90) -741 09/01/014 08/1/016 Fax: (90) 58-5970 09/01/014 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 5405 09/01/014 08/1/016 DYNAMIC FAMILY SOLUTIONS, ONE WALDO BLVD SUITE, MANITOWOC, WI 540 09/01/014 08/1/016 11/4/015 age 155 of 186

NETT-WORK FAMILY COUNSELING, LLC 801 CALUMET DRIVE SHEBOYGAN, WI 508 Sheboygan County Lic #: 1656 CHRISTINE L. NETT Initial Cert: 0/7/1998 office@nett-workfamilycounseling.or Phone: (90) 451-6908 0/01/014 0/9/016 Fax: (90) 458-649 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 1011-10TH STREET #1, MANITOWOC, WI 540 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 140 MILWAUKEE DR, NEW HOLSTEIN, WI 5061 0/01/014 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 5081 0/01/014 0/9/016 NORTHSHORE CLINIC LLC 805 NORTH 6TH STREET SHEBOYGAN, WI 5081 Sheboygan County Lic #: 1699 LORI DIELENTHEIS Initial Cert: 08/01/1991 nsc@northshoreclinic.org Phone: (90) 457-8866 0/01/014 01/1/016 Fax: (90) 457-8867 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 01/1/016 0/01/014 01/1/016 SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 184 1011 N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County JODY A GALLAWAY, PSYD Initial Cert: 07/01/1986 jody.gallaway@sheboygancounty.co Phone: (90) 459-155 10/01/014 09/0/016 Fax: (90) 459-45 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 15 1011 NORTH 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County ERIC BRUNNICH Initial Cert: 07/01/1996 eric.brunnich@countysheboygan.co Phone: (90) 459-199 10/01/01 09/0/015 Fax: (90) 459-6459 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 10/01/01 09/0/015 11/4/015 age 156 of 186

SHEBOYGAN COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 667 1011 N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County AMY CULVER Initial Cert: 05/01/006 culveajc@co.sheboygan.wi.us Phone: (90) 459-171 06/01/014 05/1/016 Fax: (90) 459-45 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 jeff.stumbras@prevea.com Phone: (90) 7-100 1/01/015 11/0/017 Fax: (90) 7-101 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/015 11/0/017 1/01/015 11/0/017 11/4/015 age 157 of 186

Taylor County ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. 14 SOUTH GIBSON ST MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong Lic #: 1577 ROBB FABICH Initial Cert: 01/01/1978 robb.fabich@aspirus.org Phone: (715) 748-11 09/01/015 08/1/017 Fax: (715) 748-7590 09/01/015 08/1/017 1 ASPIRUS PHILLIPS CLINIC, 65 PETERSON AVE, PHILLIPS, WI 54555 09/01/015 08/1/017 1 ASPIRUS PRENTICE CLINIC, 1511 RAILROAD AVE, PRENTICE, WI 54556 09/01/015 08/1/017 COUNSELING CONNECTION OF MEDFORD 1 WEST STATE STREET, #4 MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong Lic #: 75 KELLY SCHULTZ Initial Cert: 09/01/007 counselingconnection@tds.net Phone: (715) 748-41 09/01/014 08/1/016 Fax: (715) 748-4407 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 1 CADOTT MEDICAL CENTER-COUNSELING CONNECTION, NORTH MAIN ST, CADOTT, WI 5477 09/01/014 08/1/016 1 PHOENIX HOUSE, 600 W. HICKORY STREET, GILMAN, WI 544 08/1/016 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 54451 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 NORTH CENTRAL COUNSELING CENTER 16 W. BROADWAY MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong Lic #: 1675 DEBRA KOLTIS Initial Cert: 1/01/1994 northcentral@tds.net Phone: (715) 748-455 09/01/015 06/0/017 Fax: (715) 748-067 09/01/015 06/0/017 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT Lic #: 1898 540 E. COLLEGE STREET MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 06/01/198 jen.meyer@co.taylor.wi.us Phone: (715) 748-07/01/014 06/0/016 Fax: (715) 748-4 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

TAYLOR COUNTY HUMAN SERVICES DEPARTMENT CCS PROGRAM Lic #: 080 540 E COLLEGE ST MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 07/01/015 jen.meyer@co.taylor.wi.us Phone: (715) 748-07/01/015 06/0/016 Fax: (715) 748-4 CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 Trempealeau County MAYO CLINIC FRANCISCAN HEALTH CARE COMMUNITY SUPPORT PROGRAM Lic #: 171 464 S. ST. JOSEPHS AVENUE ARCADIA, WI 5461 Trempealeau County Surveyor: Roderic Senn JANET BUTLER Initial Cert: 0/01/199 Butler.janet@mayo.edu Phone: (608) -7775 0/01/015 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 #: 54 06 WHITEHALL RD INDEPENDENCE, WI 54747 Trempealeau County Surveyor: Roderic Senn TODD PYKA Initial Cert: 09/0/004 tpyka@tchcc.com Phone: (715) 84-81 09/01/015 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 #: 094 645 MAIN ST WHITEHALL, WI 5477 Trempealeau County Surveyor: Roderic Senn DEBRA SUCHLA Initial Cert: 09/01/015 debras@tremplocounty.com Phone: (715) 58-11 09/01/015 08/1/016 Fax: (715) 58-4174 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

Vernon County CENTER POINT COUNSELING SERVICES COOPERATIVE Lic #: 955 10 AIRPORT RD SUITE 10 VIROQUA, WI 54665 Vernon County SHERI HAMMOND shammond@centerpoint.coop Phone: (608) 68-740 Fax: (608) 68-749 Initial Cert: 1/01/011 1 1 1 BETHEL HOME & SERVICES, 614 SOUTH ROCK AVENUE, VIROQUA, WI 54665 BETHEL HOME & SERVICES, 60 SOUTH GARFIELD, VIROQUA, WI 54665 CENTER POINT CNSLNG SVS VERNON MANOR, E7404A COUNTY ROAD BB, VIROQUA, WI 54665 COON VALLEY ELEMENTARY SCHOOL, 00 LIEN STREET, COON VALLEY, WI 546 VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DRIVE, VIROQUA, WI 54665 VIROQUA ELEMENTARY SCHOOL, 115 NORTH EDUCATION AVE, VIROQUA, WI 54665 WESTBY ELEMENTARY SCHOOL, 1 NELSON STREET, WESTBY, WI 54667 WESTBY MIDDLE & HIGH SCHOOL, 06 WEST AVENUE SOUTH, WESTBY, WI 54667 FAMILY AND CHILDREN'S CENTER, INC. COMMUNITY SUPPORT PROGRAM Lic #: 117 11 N MAIN ST VIROQUA, WI 54665 Vernon County Surveyor: Roderic Senn SUZIE HOWE Initial Cert: 01/01/1996 showe@fccnetwork.org Phone: (608) 67-705 05/01/015 04/0/017 Fax: (608) 67-8500 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 05/01/015 04/0/017 PSYCHIATRIC ASSOCIATES COUNSELING CENTER LLC Lic #: 1754 1 W SOUTH STREET VIROQUA, WI 54665 Vernon County Surveyor: Roderic Senn JULIE NOTH Initial Cert: 08/01/1987 JCN1@mwt.net Phone: (608) 67-511 06/01/014 05/1/016 Fax: (608) 67-791 06/01/014 05/1/016 1 PSYCHIATRIC ASSOCIATES COUNSELING CENTER, 66 EAST AVENUE SOUTH, LA CROSSE, WI 5460 06/01/014 05/1/016 STRIVE COMPREHENSIVE COMMUNITY SERVICES Lic #: 09 18 FAIRLANE DRIVE SUITE 100 VIROQUA, WI 54665 Vernon County Surveyor: Roderic Senn REBECCA MILLER Initial Cert: 08/01/015 striveccs@centerpoint.coop Phone: (608) 67-510 08/01/015 07/1/016 Fax: (608) 67-5505 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

VERNON COUNTY DEPT OF HUMAN SERVICES/CENTER POINT COUNSELING SERVICES COOP Lic #: 960 10 AIRPORT RD, SUITE 10 VIROQUA, WI 54665 Vernon County Surveyor: Roderic Senn PAM EITLAND Initial Cert: 1/01/011 peitland@vernoncounty.org Phone: (608) 67-510 1/01/014 11/0/016 Fax: (608) 67-5505 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 HIDDEN SPRINGS CLINIC S 1597 HANSON ROAD WESTBY, WI 54667 Vernon County Surveyor: Roderic Senn Lic #: 565 DEAN JENSEN Initial Cert: 1/09/004 hscdeanj@yahoo.com Phone: (608) 574-058 07/01/014 06/0/016 Fax: (608) 64-6918 07/01/014 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 dwildcat@ldftribe.com Phone: (715) 588-1511 11/01/015 1/1/015 Fax: (715) 588-90 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/015 1/1/015 11/01/015 1/1/015 1 DOMESTIC ABUSE PROGRAM, 157 CEDAR AVENUE, LAC DU FLAMBEAU, WI 5458 07/06/016 1/1/015 1 SOBER HOME - MEN'S, 119 ARNOLD STOCK ROAD, LAC DU FLAMBEAU, WI 5458 07/06/016 1/1/015 1 SOBER HOME - WOMEN'S, 55 BOBIDOSH POINT LANE, LAC DU FLAMBEAU, WI 5458 07/06/016 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 54548 11/01/015 1/1/015 11/01/015 1/1/015 LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS Lic #: 071 19 OLD ABE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong RYAN CHAMPAGNE Initial Cert: 0/01/015 RChampagne@ldftribe.com Phone: (715) 588-71 0/01/015 01/1/016 Fax: (715) 588-09 CCS REGIONAL MODEL POPULATION-BASED DHS 6 0/01/015 01/1/016 11/4/015 age 161 of 186

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 ksteen@credencetherapy.org Phone: (6) 7-44 1/01/014 11/0/016 Fax: (6) 7-808 CSAS-OUTPATIENT TREATMENT DHS 75.1 1/01/014 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 511 10/1/015 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 lkadlec@co.walworth.wi.us Phone: (6) 741-00 1/01/015 11/0/017 Fax: (6) 741-17 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 lkadlec@co.walworth.wi.us Phone: (6) 741-00 0/01/015 01/1/017 Fax: (6) 741-17 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 01/1/017 11/4/015 age 16 of 186

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 nevicosi@co.walworth.wi.us Phone: (6) 741-00 09/01/014 08/1/016 Fax: (6) 741-17 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 #: 517 146 E GENEVA SQUARE LAKE GENEVA, WI 5147 Walworth County Surveyor: William Rohner KATE CONNELLY Initial Cert: 0/01/004 kate.connelly@aurora.org Phone: (6) 49-460 0/01/015 01/1/017 Fax: (6) 7-48 1 AMG BEHAVIORAL HEALTH SERVICES-ELKHORN, 01 E. MORRISEY DRIVE, ELKHORN, WI 511 1 AURORA HEALTH CENTER - DELAVAN, 1550 HOBBS DRIVE, DELAVAN, WI 5115 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 LAKE GENEVA WELLNESS CLINIC Lic #: 149 101 BROAD STREET, #01 LAKE GENEVA, WI 5147 Walworth County Surveyor: William Rohner ERIKA FOUNTAIN Initial Cert: 0/01/1984 lakegenevawellnessclinic@yahoo.co Phone: (6) 48-794 04/01/015 0/1/017 Fax: (6) 48-10 04/01/015 0/1/017 WHEATLAND CENTER SCHOOL, 6606 68TH AVENUE, BURLINGTON, WI 5105 09/09/015 0/1/017 11/4/015 age 16 of 186

Washburn County SOAR SERVICES, INC. 46 INDUSTRIAL DRIVE SHELL LAKE, WI 54871 Washburn County Surveyor: Polly Wong Lic #: 506 MICHAEL TURGEON Initial Cert: 0/11/004 soarcounseling@hotmail.com Phone: (715) 468-841 04/01/014 0/1/016 Fax: (715) 468-74 04/01/014 0/1/016 SOAR COUNSELING SERVICES, 517 BEASER AVENUE, ASHLAND, WI 54806 04/01/014 0/1/016 ACCESS, INC. 4851 HWY 6 SOUTH SPOONER, WI 54801 Washburn County Surveyor: Polly Wong Lic #: 61 ANDREW WOLF Initial Cert: 01/01/006 awolf@auroraservices.com Phone: (715) 65-4858 01/01/014 1/1/015 Fax: (715) 65-4861 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 5470 08/01/014 1/1/015 1 ACCESS, INC, 100 POLK COUNTY PLAZA, #70, BALSAM LAKE, WI 54810 08/01/014 1/1/015 1 ACCESS, INC, 0 E LASALLE STREET, BARRON, WI 5481 01/01/014 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 555 JENSON DR., MEDFORD, WI 54451 10/1/016 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 915 INDIANHEAD DR., MOSINEE, WI 54455 08/01/014 10/01/014 ACCESS, INC - LADYSMITH, 108 W. ND STREET N, LADYSMITH, WI 54848 ACCESS, INC - LADYSMITH, 804 W 9TH STREET N, SUITE B, LADYSMITH, WI 54848 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 54801 ACCESS INC-LADYSMITH ELEMENTARY SCHOOL, 64 EAST 6TH STREET, LADYSMITH, WI 54848 ACCESS, INC - BRUCE MIDDLE SCHOOL, 104 W WASHINGTON AVE, BRUCE, WI 54819 ACCESS, INC - SPOONER MIDDLE SCHOOL, 750 OAK STREET, SPOONER, WI 54801 ACCESS, INC-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET SOUTH, LADYSMITH, WI 54848 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 54840 08/0/015 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 #: 96 70 FRONT STREET SPOONER, WI 54801 Washburn County Surveyor: Polly Wong MS. ANJULI (AJ) SIMON Initial Cert: 11/01/010 ajsimon@co.washburn.wi.us Phone: (715) 65-086 11/01/015 10/1/017 Fax: (715) 65-59 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/015 10/1/017 11/4/015 age 164 of 186

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 mtonnacliff@wlcfs.org Phone: (6) 45-555 1/01/014 11/0/016 Fax: (6) 45-551 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 504 08/0/015 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, 17100 W NORTH AVENUE, #0, BROOKFIELD, WI 5005 1/01/014 11/0/016 1 WLCFS-CHRISTIAN FAMILY COUNSELING, 9555 S HOWELL AVENUE, #750, OAK CREEK, WI 5154 1/01/014 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 #: 176 1567 E. SUMNER STREET HARTFORD, WI 507 Washington County GINA SINGLETERY Initial Cert: 04/01/1994 gina.singletery@corizonhealth.com Phone: (6) 67-4477 04/01/014 0/1/016 Fax: (6) 67-4477 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 11/4/015 age 165 of 186

FAMILYMEANS 1875 NORTHWESTERN AVENUE, S. STILLWATER, MN 5508 Washington County (MN) Surveyor: Roderic Senn Lic #: 14 PATRICIA ROGERS Initial Cert: 0/01/1989 familymeans@familymeans.org Phone: (651) 49-4840 05/01/014 04/0/016 Fax: (651) 49-4894 05/01/014 04/0/016 1 FAMILYMEANS, 17 VINE STREET, #105, HUDSON, WI 54016 05/01/014 04/0/016 HUDSON HIGH SCHOOL, 1501 VINE ST., HUDSON, WI 54016 HUDSON MIDDLE SCHOOL, 100 CARMICHAEL RD, HUDSON, WI 54016 NEW RICHMOND HIGH SCHOOL, 650 RICHMOND WAY, NEW RICHMOND, WI 54017 ROCK ELEMENTARY SCHOOL, 40 1TH ST. N, HUDSON, WI 54016 04/7/016 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 acs001@affiliatedclinical.com Phone: (6) 8-717 06/01/015 06/0/016 Fax: (6) 8-9767 CSAS-OUTPATIENT TREATMENT DHS 75.1 06/01/015 06/0/016 06/01/015 06/0/016 AFFILIATED CLINICAL SERVICES INC, 8 SELL DRIVE #B, HARTFORD, WI 507 06/01/015 06/0/016 WEST BEND EAST & WEST HIGH SCHOOL, 105 E. DECORAH RD., RM N 15, WEST BEND, WI 5095 06/01/015 06/0/016 GENESIS BEHAVIORAL SERVICES, INC. WEST BEND OUTPATIENT CLINIC Lic #: 1465 166 CLARENCE COURT WEST BEND, WI 5095 Washington County GINA SINGLETERY Initial Cert: 01/01/1987 Gina.singletery@corizonhealth.com Phone: (414) 777-1570 01/01/014 1/1/015 Fax: (414) 777-1565 CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/014 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 maureen.murphy@co.washington.w Phone: (6) 5-458 05/01/015 04/0/017 Fax: (6) 5-687 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

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 eric.diamond@co.washington.wi.us Phone: (6) 5-4599 05/01/014 04/0/016 Fax: (6) 5-687 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 Eric.Diamond@co.washington.wi.us Phone: (6) 5-4599 0/01/014 0/9/016 Fax: (6) 5-687 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

Waukesha County CORNERSTONE COUNSELING SERVICES, INC. 1655 W. BLUEMOUND ROAD, #00 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 17 SANDRA ADAMS Initial Cert: 0/01/199 ccshelp@ccs.com Phone: (6) 789-1191 0/01/014 0/9/016 Fax: (6) 81-6180 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 1 CORNERSTONE COUNSELING SERVICES, INC., 10 S MAIN STREET, #10, JEFFERSON, WI 5549 0/01/014 0/9/016 CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 50, MILWAUKEE, WI CORNERSTONE COUNSELING SERVICES, INC., 10850 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) 785-9188 04/01/015 0/1/017 Fax: (6) 785-0644 04/01/015 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 tiptonm@matc.edu Phone: (414) 610-995 0/01/014 01/1/016 Fax: (6) 641-9768 0/01/014 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 pathwaycc@sbcglobal.net Phone: (6) 641-9790 0/01/015 01/1/016 Fax: (6) 641-9791 0/01/015 01/1/016 11/4/015 age 168 of 186

WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH HOSPITAL II Lic #: 654 1950 W CAPITOL DR ND FLOOR BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner CAROL HESS Initial Cert: 07//005 Carol.Hess@wfhc.org Phone: (414) 874-688 09/01/015 08/1/017 Fax: (414) 874-691 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/015 08/1/017 09/01/015 08/1/017 1 WHEATON FRANCISCAN BEHAVIORAL HEALTH, 19 CAPITOL DRIVE, PEWAUKEE, WI 507 09/01/015 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 kim.schutt-chardon@wiautism.com Phone: (608) 66-97 06/01/014 05/1/016 Fax: (608) 66-9041 06/01/014 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 info@therediclinic.com Phone: (6) 646-1170 10/01/014 09/0/016 Fax: (6) 646-067 MENTAL HEALTH-DAY TREATMENT DHS 61.75 10/01/014 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 francinedixon@dominionllc.org Phone: (6) 751-7507 11/01/015 10/1/017 Fax: (6) 5-7567 11/01/015 10/1/017 11/4/015 age 169 of 186

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 ldunn@froedterthealth.org Phone: (6) 57-580 09/01/014 08/1/016 Fax: (6) 57-570 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-OUTPATIENT TREATMENT DHS 75.1 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 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 Joanne.sznaider@Froedtert.com Phone: (6) 50-00 10/01/015 09/0/017 Fax: (6) 5-9585 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 rpupp@norriscenter.org Phone: (6) 66-5900 0/01/015 0/8/017 Fax: (6) 66-5688 0/01/015 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 klotz@rogershospital.org Phone: (6) 646-4411 11/01/015 10/1/017 Fax: (6) 646-158 CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREAT/CHLDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 11/4/015 age 170 of 186

ROGERS MEMORIAL HOSPITAL - SILVER LAKE OUTPATIENT CENTER Lic #: 099 105 CORPORATE CENTER DRIVE OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner KEITH MOREHOUSE Initial Cert: 09/8/015 kmorehouse@rogershospital.org Phone: (6) 464-1144 09/8/015 10/1/016 Fax: (6) 646-1049 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 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 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 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 s_clinic@hotmail.com Phone: (6) 567-767 06/01/014 05/1/016 Fax: (6) 567-097 06/01/014 05/1/016 A HEALING CENTER/EFFICIENCY MANAGEMENT CONSULTING, S.C. Lic #: 1001 0860 WATERTOWN ROAD WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner KAREN CRNKOVICH Initial Cert: 09/01/1987 karenc@ahealingcenter.net Phone: (6) 81-6117 01/01/014 1/1/015 Fax: (6) 81-6119 01/01/014 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 kate.connelly@aurora.org Phone: (414) 454-6506 05/01/014 04/0/016 Fax: (414) 454-6450 CSAS-OUTPATIENT TREATMENT DHS 75.1 05/01/014 04/0/016 05/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER - BROOKFIELD, 16985 WEST BLUEMOUND ROAD, BROOKFIE 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, 14555 W NATIONAL AVE, NEW BERLIN, WI 51 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-WAUKESHA, 6500 AURORA DRIVE, SUMMIT, WI 5066 05/01/014 04/0/016 11/4/015 age 171 of 186

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 shubbell@bethany.org Phone: (6) 547-6557 06/01/015 05/1/016 Fax: (6) 547-644 06/01/015 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 mbibo@ccmke.org Phone: (414) 769-415 05/01/015 04/0/017 Fax: (414) 769-48 05/01/015 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 lcherone@fswaukesha.org Phone: (6) 547-5567 0/01/014 01/1/016 Fax: (6) 547-1608 0/01/014 01/1/016 FAMILY SERVICE OF WAUKESHA, 119A SILVER LAKE STREET, OCONOMOWOC, WI 5066 0/01/014 06/07/014 FAMILY SERVICE OF WAUKESHA, 175 EAST WISCONSIN AVE STE H, OCONOMOWOC, WI 5066 06/08/014 01/1/016 FAMILY SERVICE OF WAUKESHA, 76 N EAST AVENUE, WAUKESHA, WI 5186 0/01/014 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 5186 0/01/014 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 emily@hhcppo.com Phone: (414) 06-6550 08/01/014 07/1/016 Fax: (414) 06-6550 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

PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES Lic #: 1974 71 AMERICAN AVENUE #501 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner O. KIRK YAUCHLER Initial Cert: 06/01/1986 Olin.yauchler@phci.org Phone: (6) 98-406 01/01/015 1/1/015 Fax: (6) 98-5096 CSAS-OUTPATIENT TREATMENT DHS 75.1 01/01/015 1/1/015 01/01/015 1/1/015 1 PHCMA, INC. BEHAVIORAL HEALTH SVS - BIG BEND RD, 10 BIG BEND ROAD, WAUKESHA, WI 5189 01/01/015 1/1/015 1 PHCMA, INC. BEHAVIORAL HEALTH SVS - DELAFIELD, 750 GOLF ROAD, DELAFIELD, WI 5018 1/01/015 1/1/015 1 PROHEALTH CARE SLEEP CENTER, 01 SUN VALLEY DRIVE #00, DELAFIELD, WI 5018 01/01/015 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 BMC @ 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 #: 1887 717 N. GRANDVIEW BLVD., #0 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner PAUL GLASS Initial Cert: 10/01/1990 waukesha@stressmanagementclinic Phone: (6) 544-6486 10/01/015 09/0/016 Fax: (6) 544-677 10/01/015 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 dbirdeau@waukeshacounty.gov Phone: (6) 548-7978 07/01/014 06/0/016 Fax: (6) 896-8180 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 5188 07/01/014 06/0/016 11/4/015 age 17 of 186

WAUKESHA COUNTY HEALTH AND HUMAN SERVICES-COMMUNITY SUPPORT PROGRAM Lic #: 197 1501 AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner BRAD HAAS Initial Cert: 10/01/1990 bhaas@waukeshacounty.gov Phone: (6) 548-7950 10/01/015 09/0/017 Fax: (6) 896-8046 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 gowley@waukeshacounty.gov Phone: (6) 548-7666 05/01/015 04/0/017 Fax: (6) 548-7656 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 5188 05/01/015 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 jlewis@waukeshacounty.gov Phone: (6) 548-7950 05/01/014 04/0/016 Fax: (6) 896-8046 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 05/01/014 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 julie.gingras@phci.org Phone: (6) 98-4 01/01/015 1/1/016 Fax: (6) 98-816 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 11/4/015 age 174 of 186

Waupaca County RAWHIDE YOUTH & FAMILY COUNSELING SERVICES Lic #: 750 E7475 RAWHIDE ROAD NEW LONDON, WI 54961 Waupaca County KELLY WISNEFSKE Initial Cert: 08//007 Kwisnefske@rawhide.org Phone: (877) 00-9101 09/01/015 08/1/017 Fax: (90) 98-5040 09/01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 0 N MAIN STREET, #01, WEST BEND, WI 5095 09/01/015 08/1/017 1 RAWHIDE YOUTH & FAMILY COUNSELING SVS, 446 WESTHILL BLVD SUITE 6, APPLETON, WI 54914 09/01/015 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 540 09/01/015 08/1/017 MINISTRY BEHAVIORAL HEALTH 190 GRAND SEASONS DRIVE WAUPACA, WI 54981 Waupaca County Lic #: 645 TERESA TAYLOR Initial Cert: 0/01/006 terri.taylor@ministryhealth.org Phone: (715) 58-8459 0/01/014 01/1/016 Fax: (715) 58-0878 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/014 01/1/016 0/01/014 01/1/016 WAUPACA COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES CSP Lic #: 1 811 HARDING STREET WAUPACA, WI 54981 Waupaca County CHUCK PRICE Initial Cert: 1/01/1981 wcdhhs@co.waupaca.wi.us Phone: (715) 58-65 07/01/014 06/0/016 Fax: (715) 58-6409 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 07/01/014 06/0/016 WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 1977 811 HARDING STREET WAUPACA, WI 54981 Waupaca County CHUCK PRICE Initial Cert: 1/01/1981 wcdhhs@co.waupaca.wi.us Phone: (715) 58-604 07/01/014 06/0/016 Fax: (715) 58-6409 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 54961 07/01/014 06/0/016 11/4/015 age 175 of 186

NORTHWEST JOURNEY - WAUPACA 10 E MAIN STREET WEYAUWEGA, WI 5498 Waupaca County Lic #: 9 LAURA KOWALSKI Initial Cert: 08/05/010 nwjwaupaca@nwcgc.com Phone: (90) 867-4744 09/01/015 08/1/017 Fax: (90) 867-41 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

Waushara County ALL AREA COUNSELING SERVICES-A DIVISION OF OPTIONS TREATMENT PROGRAMS INC Lic #: 51 719 W MAIN STREET WAUTOMA, WI 5498 Waushara County KIMEKO HAGEN Initial Cert: 04/01/004 khagen@optionstx.com Phone: (90) 787-747 04/01/014 0/1/016 Fax: (90) 787-5458 CSAS-OUTPATIENT TREATMENT DHS 75.1 04/01/014 0/1/016 04/01/014 0/1/016 1 INTEGRATIVE PAIN MANAGEMENT SC, 555 S WASHBURN ST #A, OSHKOSH, WI 54904 04/01/014 08/5/014 OPTIONS TREATMENT PROGRAMS, INC., 1000 N. LYNNDALE DRIVE STE C, APPLETON, WI 54914 OPTIONS TREATMENT PROGRAMS, INC., 44 S MONROE AVE #01, GREEN BAY, WI 5401 OPTIONS TREATMENT PROGRAMS, INC., 9 CHURCHILL ST, WAUPACA, WI 54981 OPTIONS TREATMENT PROGRAMS-OSHKOSH, 50 E. NEW YORK AVE., OSHKOSH, WI 54901 04/01/014 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 #: 1980 0 W. PARK STREET WAUTOMA, WI 5498 Waushara County TONI MORGAN JONES Initial Cert: 10/01/1975 tonimj.parkstreet@co.waushara.wi.u Phone: (90) 787-6550 11/01/014 10/1/016 Fax: (90) 787-041 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 549 11/01/014 10/1/016 TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 54966 11/01/014 10/1/016 WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI 5498 11/01/014 10/1/016 WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI 5964 11/01/014 10/1/016 WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI 54984 11/01/014 10/1/016 WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: 1979 1 W. PARK STREET WAUTOMA, WI 5498 Waushara County RENEE SOROKO Initial Cert: 08/01/1997 renees.parkstreet@co.waushara.wi. Phone: (90) 787-6550 11/01/014 10/1/016 Fax: (90) 787-041 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 age 177 of 186

WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 618 0 W PARK STREET WAUTOMA, WI 5498 Waushara County RENEE SOROKO Initial Cert: 10/19/005 renees.parkstreet@co.waushara.wi. Phone: (90) 787-6550 11/01/014 10/1/016 Fax: (90) 787-041 CCS REGIONAL MODEL SHARED SERVICES DHS 6 11/01/014 10/1/016 11/4/015 age 178 of 186

Winnebago County PARTNERSHIP COMMUNITY HEALTH CENTER 1814 N APPLETON ROAD MENASHA, WI 5495 Winnebago County Lic #: 794 KRISTENE STACKER Initial Cert: 07/01/008 kristene.stacker@thedacare.org Phone: (90) 750-6611 07/01/015 06/0/017 Fax: (90) 88-946 07/01/015 06/0/017 1 EMERGENCY SHELTER OF THE FOX VALLEY, 400 N DIVISION STREET, APPLETON, WI 54911 07/01/015 06/0/017 THE COUNSELING CLINIC-FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: 1 1810 APPLETON ROAD MENASHA, WI 5495 Winnebago County HOLLY KEYSER Initial Cert: 0/01/198 Phone: (90) 79-46 1/01/014 11/0/016 Fax: (90) 79-769 1/01/014 11/0/016 GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR, GREENVILLE, WI 5494 1/01/014 09/09/015 HORTONVILLE HIGH SCHOOL, 11 E TOWNE DR., HORTONVILLE, WI 54944 1/01/014 11/0/016 HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST., HORTONVILLE, WI 54944 1/01/014 11/0/016 JR GERRITS MIDDLE SCHOOL, 545 SOUTH JOHN ST, KIMBERLY, WI 5416 1/01/014 11/0/016 KAUKAUNA HIGH SCHOOL, 1701 COUNTY ROAD CE, KAUKAUNA, WI 5410 1/01/014 11/0/016 KIMBERLY HIGH SCHOOL, 166 E KENNEDY AVE, KIMBERLY, WI 5416 1/01/014 11/0/016 LITTLE CHUTE HIGH SCHOOL, 140 FREEDOM ROAD, LITTLE CHUTE, WI 54140 1/01/014 11/0/016 NEENAH HIGH SCHOOL, 175 TULLAR RD, NEENAH, WI 54956 1/01/014 11/0/016 SHATTUCK MIDDLE SCHOOL, 600 ELM STREET, NEENAH, WI 54956 1/01/014 11/0/016 THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY Lic #: 155 1478 KENWOOD DRIVE SUITE 1 MENASHA, WI 5495 Winnebago County ROSANGELA BERBERT Initial Cert: 0/01/198 rberbert@samaritan-counseling.com Phone: (90) 886-919 0/01/015 0/8/017 Fax: (90) 886-957 CSAS-OUTPATIENT TREATMENT DHS 75.1 0/01/015 0/8/017 0/01/015 0/8/017 1 PROJECT OPEN DOOR IMMANUEL UNITED CHURCH, 510 SULLIVAN AVENUE, KAUKAUNA, WI 5410 0/01/015 0/8/017 1 THE SAMARITAN COUNSELING CENTER OF FV AT LHCC, 510 DOCTORS COURT, OSHKOSH, WI 54901 0/19/016 0/8/017 1 THE SAMARITAN COUNSELING CTR FOX VALLEY, 1478 MIDWAY ROAD, MENASHA, WI 5495 0/01/015 0/8/017 THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI 54901 THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI 54961 0/01/015 0/8/017 0/01/015 0/8/017 11/4/015 age 179 of 186

THEDACARE BEHAVIORAL HEALTH 1095 MIDWAY ROAD MENASHA, WI 5495 Winnebago County Lic #: 05 JEAN DEKEYSER, RN, MS Initial Cert: 07/1/1998 jean.dekeyser@thedacare.org Phone: (90) 70-00 07/01/014 06/0/016 Fax: (90) 70-719 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 61.75 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 THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI 54961 07/01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI 54166 THEDACARE BEHAVIORAL HEALTH, 1818 NORTH MEADE STREET, APPLETON, WI 54911 THEDACARE BEHAVIORAL HEALTH, 500 E CAPITAL DRIVE, APPLETON, WI 54911 THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI 54901 THEDACARE BEHAVIORAL HEALTH, 90 RIVERSIDE DRIVE, #04, WAUPACA, WI 54981 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 REACH COUNSELING SERVICES 1509 S COMMERCIAL STREET NEENAH, WI 54956 Winnebago County Lic #: 180 LYN BEYER Initial Cert: 01/11/199 lyns@reachcounseling.com Phone: (90) 7-8150 01/01/015 1/1/016 Fax: (90) 7-014 1 REACH COUNSELING SERVICES, INC., 414 DOCTORS COURT, SUITE 110, OSHKOSH, WI 54901 1 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 #: 1946 10 SECOND STREET NEENAH, WI 54956 Winnebago County COLLETTE HARTFIEL Initial Cert: 0/01/198 collette.hartfiel@thedacare.org Phone: (90) 79-0 0/01/015 01/1/017 Fax: (90) 79-906 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 01/1/017 0/01/015 01/1/017 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 006 11 N COMMERCIAL STREET NEENAH, WI 54956 Winnebago County MICHAEL DAEHN PHD Initial Cert: 07/01/1988 mdaehn@co.winnebago.wi.us Phone: (90) 79-777 11/01/014 10/1/016 Fax: (90) 70-968 CSAS-OUTPATIENT TREATMENT DHS 75.1 11/01/014 10/1/016 11/01/014 10/1/016 11/4/015 age 180 of 186

WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES CSP Lic #: 78 11 N. COMMERCIAL STREET NEENAH, WI 54956 Winnebago County KATHLEEN RASMUSSEN Initial Cert: 11/01/000 krasmussen@co.winnebago.wi.us Phone: (90) 79-777 11/01/014 10/1/016 Fax: (90) 70-968 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 AURORA MEDICAL GROUP OSHKOSH 700 N WESTHAVEN DRIVE OSHKOSH, WI 54904 Winnebago County Lic #: 540 KATE SIEBERS Initial Cert: 09/01/004 kate.siebers@aurora.org Phone: (90) 456-00 09/01/015 08/1/017 Fax: (90) 456-05 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 5414 09/01/015 08/1/017 1 AURORA MEDICAL GROUP OSHKOSH, 414 DOCTORS COURT, OSHKOSH, WI 54901 09/01/015 08/1/017 1 AURORA MEDICAL GROUP OSHKOSH, 855 N WESTHAVEN DR, OSHKOSH, WI 54904 09/01/015 08/1/017 AURORA MEDICAL GROUP OSHKOSH, 116 WESTOWNE DR, NEENAH, WI 54956 AURORA MEDICAL GROUP OSHKOSH, 14 W FOND DU LAC STREET, RIPON, WI 54971 AURORA MEDICAL GROUP OSHKOSH, 10 WISCONSIN AMERICAN DRIVE, FOND DU LAC, WI 5495 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 MERCY COUNSELING SERVICES 500 SOUTH OAKWOOD RD OSHKOSH, WI 54904 Winnebago County Lic #: 161 TINA LECHNIR Initial Cert: 0/01/1995 tlechnir@affinityhealth.org Phone: (90) 6-8570 09/01/014 08/1/016 Fax: (90) 6-8591 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 MERCY MEDICAL CENTER 500 S OAKWOOD ROAD OSHKOSH, WI 54904 Winnebago County Lic #: 1608 TINA LECHNIR Initial Cert: 0/01/198 tlechnir@affinityhealth.org Phone: (90) -400 09/01/014 08/1/016 Fax: (90) -404 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 08/1/016 09/01/014 08/1/016 11/4/015 age 181 of 186

OSHKOSH COUNSELING CENTER, INC. 501 MERRITT AVENUE OSHKOSH, WI 54901 Winnebago County Lic #: 17 RACHELLE LAUX Initial Cert: 09/01/1985 occ@oshcc.com Phone: (90) 1-858 1/01/014 11/0/016 Fax: (90) 1-4048 1/01/014 11/0/016 SHERMAN CONSULTING OSHKOSH 70 STATE ROAD 44, #D OSHKOSH, WI 54904 Winnebago County Lic #: 58 HANK SHERMAN, PHD Initial Cert: 0/0/005 shermanconsultingllc@yahoo.com Phone: (90) 0-065 04/01/014 0/1/016 Fax: (90) 0-6565 04/01/014 0/1/016 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 007 0 WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN Initial Cert: 10/01/1975 mdaehn@co.winnebago.wi.us Phone: (90) 6-4700 11/01/014 10/1/016 Fax: (90) 6-1157 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-OUTPATIENT TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 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 mhoodie@co.winnebago.wi.us Phone: (90) 6-4700 11/01/014 10/1/016 Fax: (90) 6-1157 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 6 11/01/014 10/1/016 11/4/015 age 18 of 186

WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: 579 0 WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN PHD Initial Cert: 0/09/005 Mdaehn@co.winnebago.wi.us Phone: (90) 6-4700 04/01/015 0/1/017 Fax: (90) 0-479 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 WINNEBAGO MENTAL HEALTH INSTITUTE TREFFERT DRIVE & BUTLER AVENUE WINNEBAGO, WI 54985 Winnebago County Lic #: 008 THOMAS SPEECH Initial Cert: 10/01/1975 Phone: (90) 5-4910 11/01/015 10/1/017 Fax: (90) 7-04 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/015 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 55987 Winona County (MN) Surveyor: Roderic Senn Lic #: 8 JULIE HANSON Initial Cert: 09/1/009 julieh@hvmhc.org Phone: (507) 454-441 09/01/014 08/1/016 Fax: (507) 45-667 CSAS-OUTPATIENT TREATMENT DHS 75.1 09/01/014 08/1/016 09/01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 1 4TH ST. S, LA CROSSE, WI 54601 10/16/015 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 19 MAIN STREET, LA CROSSE, WI 54601 09/01/014 10/15/015 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 611 BROADWAY AVENUE, #100, WABASHA, MN 55981 09/01/014 08/1/016 HIAWATHA VALLEY MENTAL HEALTH CENTER, 85 S. SERVICE DR., STE. 10, RED WING, MN 55066 HIAWATHA VALLEY MENTAL HEALTH CENTER, LA CROSSE CNTY JUVE FAC.- 00 4TH ST NORTH, LA C 06/05/015 08/1/016 09/01/014 08/1/016 11/4/015 age 18 of 186

Wood County MARRIAGE AND FAMILY HEALTH SERVICES, LTD. Lic #: 6 501 SOUTH CHERRY AVE, #5 MARSHFIELD, WI 54449 Wood County THOMAS JOHNSTON, PHD Initial Cert: 01/01/006 MFHSEC@sbcglobal.net Phone: (715) 486-80 01/01/015 1/1/016 Fax: (715) 486-95 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, 1801 16TH STREET SOUTH, WISCONSIN RAPIDS, WI 54494 01/01/015 1/1/016 MFHS - MARSHFIELD MIDDLE SCHOOL, 900 EAST 4TH STREET, MARSHFIELD, WI 54449 01/01/015 1/1/016 MFHS - PITTSVILLE ELEMENTARY SCHOOL, 5459 ELEMENTARY AVENUE, STE #1, PITTSVILLE, WI 544 11/0/016 1/1/016 MFHS PITTSVILLE HIGH SCHOOL, 5407 1ST AVENUE, PITTSVILLE, WI 54466 01/01/015 1/1/016 MHFS - EAST JUNIOR HIGH SCHOOL, 11 LINCOLN STREET, WISCONSIN RAPIDS, WI 54494 11/0/016 1/1/016 MARSHFIELD CLINIC DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL HEALTH Lic #: 1566 1000 N OAK AVENUE MARSHFIELD, WI 54449 Wood County SANDRA BUMP Initial Cert: 1/01/198 bump.sandra@marshfieldclinic.org Phone: (715) 87-5744 1/01/014 11/0/016 Fax: (715) 87-905 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 54455 1/01/014 11/0/015 1 MARSHFIELD CLINIC WAUSAU CENTER, 77 PLAZA DRIVE, WAUSAU, WI 54401 1/01/014 11/0/016 NORWOOD HEALTH CENTER 1600 N. CHESTNUT AVENUE MARSHFIELD, WI 54449 Wood County Lic #: 1709 RHONDA KOZIK Initial Cert: 04/01/1980 rkozik@co.wood.wi.us Phone: (715) 84-188 0/01/015 01/1/017 Fax: (715) 89-66 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 01/1/017 0/01/015 01/1/017 WISE MIND MENTAL HEALTH CLINIC, LLC 601 EAST RD ST MARSHFIELD, WI 54449 Wood County Lic #: 019 PATRICIA K FABER Initial Cert: 0/1/014 wisemindmhc@gmail.com Phone: (715) 84-0080 04/01/015 0/1/017 Fax: (715) 84-0090 04/01/015 0/1/017 11/4/015 age 184 of 186

CENTRAL WISCONSIN COUNSELING ASSOCIATES Lic #: 9 0 W. GRAND AVE SUITE 04A WISCONSIN RAPIDS, WI 54495 Wood County AMY GUNDERSON Initial Cert: 01/01/001 office@cwca.biz Phone: (715) 44-6960 01/01/014 1/1/015 Fax: (715) 44-696 01/01/014 1/1/015 1 CENTRAL WISCONSIN COUNSELING ASSOCIATES, 116 STRONGS AVE, STEVENS POINT, WI 54481 01/01/014 09/06/015 1 CENTRAL WISCONSIN COUNSELING ASSOCIATES, INC, 801 ND STREET, PORT EDWARDS, WI 54469 11/01/014 1/1/015 1 CENTRAL WISONSIN COUNSELING ASSOCIATES, 95 POST ROAD, STEVENS POINT, WI 54481 09/07/015 1/1/015 LINCOLN HIGH SCHOOL, 1801-16TH STREET SOUTH, WISCONSIN RAPIDS, WI 54494 RIVER CITIES HIGH SCHOOL, 90-48TH STREET SOUTH, WISCONSIN RAPIDS, WI 54495 01/01/014 1/1/015 01/01/014 1/1/015 CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC Lic #: 981 90 8TH ST SOUTH STE #101 WISCONSIN RAPIDS, WI 54494 Wood County DEB FUEHRER Initial Cert: 09/7/01 office@drjenna.net Phone: (715) 4-00 09/01/015 08/1/016 Fax: (888) 485-441 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 54449 09/01/015 08/1/016 HUMKE ELEMENTARY, 500 S. SECTION STREET, NEKOOSA, WI 54457 WASHINGTON ELEMENTARY, 911 WASHINGTON STREET, WISCONSIN RAPIDS, WI 54494 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 54495 Wood County Lic #: 108 DR MICHAEL J NELSON Initial Cert: 10/01/1988 clinicalservices@solarus.net Phone: (715) 44-400 10/01/015 09/0/017 Fax: (715) 44-441 CSAS-INTERVENTION DHS 75.16 10/01/015 09/0/017 10/01/015 09/0/016 NORTHWEST JOURNEY - WISCONSIN RAPIDS 110-4TH STREET SOUTH WISCONSIN RAPIDS, WI 54494 Wood County Lic #: 91 LAURA DUCKETT Initial Cert: 0/1/001 LauraD@nwcgc.com Phone: (715) 44-5040 04/01/015 0/1/017 Fax: (715) 44-570 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

WOOD COUNTY HUMAN SERVICES CCS 611-1TH AVENUE, SOUTH WISCONSIN RAPIDS, WI 54494 Wood County Lic #: 678 KATHY ROETTER Initial Cert: 08/01/1977 kroetter@co.wood.wi.us Phone: (715) 41-8800 07/01/014 06/0/016 Fax: (715) 41-66 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 #: 019 611-1TH STREET SOUTH WISCONSIN RAPIDS, WI 54494 Wood County SUSAN SCHUELER-SHEVELAND Initial Cert: 08/01/1977 Phone: (715) 41-8849 07/01/014 06/0/016 Fax: (715) 41-66 CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54449 07/01/014 06/0/016 11/4/015 age 186 of 186