2802
Lic #:
COUNSELING ASSOCIATES LLC
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 05/31/2016 06/01/2015 06/05/2008 (608) 785-0273 (608) 785-0827 [email protected] MARIO EINSMAN La Crosse County LA CROSSE, WI 54601 115 - 5TH AVENUE SOUTH, #301
Service Begin / End Dates
Adm Code
06/01/2015 05/31/2016 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
06/01/2015 05/31/2016 COUNSELING ASSOCIATES LLC, 111 MARKET STREET #4A, WINONA, MN 55987
2
3021
Lic #:
DRIFTLESS RECOVERY SERVICES INC
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 03/31/2017 04/01/2015 04/14/2014 (608) 519-5909 (608) 519-5908 [email protected] BRETT KNUTSON La Crosse County LA CROSSE, WI 54601 444 MAIN ST SUITE 301
Service Begin / End Dates
Adm Code
04/01/2015 03/31/2017 CSAS-OUTPATIENT TREATMENT DHS 75.13
04/01/2015 03/31/2017 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
NO BRANCH LOCATIONS
1315
Lic #:
FAMILY AND CHILDREN'S CENTER
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 10/31/2017 11/01/2015 02/01/1994 (608) 785-0002 (608) 785-0001 [email protected] VANESSA SOUTHWORTH La Crosse County LA CROSSE, WI 54601 1707 MAIN STREET
Service Begin / End Dates
Adm Code
11/01/2015 10/31/2017 CSAS-OUTPATIENT TREATMENT DHS 75.13
11/01/2015 10/31/2017 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
11/01/2015 10/31/2017 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11(2)
Tier
Branch Location ( s )
Branch Begin / End Dates
11/01/2015 10/31/2017 FAMILY AND CHILDREN'S CENTER, 1321 NORTH MAIN ST, VIROQUA, WI 54665
1391
Lic #:
GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 11/30/2016 12/01/2014 02/01/1984 (608) 775-6055 (608) 775-6439 [email protected] SARAH MELDE La Crosse County LA CROSSE, WI 54601 1836 SOUTH AVENUE
Service Begin / End Dates
Adm Code
12/01/2014 11/30/2016 CSAS-OUTPATIENT TREATMENT DHS 75.13
12/01/2014 11/30/2016 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
12/01/2014 11/30/2016 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35
Tier
Branch Location ( s )
Branch Begin / End Dates
12/01/2014 11/30/2016 GUNDERSEN CLINIC LTD,, 18606 ERVIN STREET, WHITEHALL, WI 54773
1
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD, 226 NORTH 2ND STREET, LA CRESCENT, MN 55947
1
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD, 805 MAIN AVE SOUTH, HARMONY, MN 55939
1
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA 52175
1
12/01/2014 11/30/2016 GUNDERSON CLINIC LTD, 35791 OSSEO ROAD, INDEPENDENCE, WI 54747
1
12/01/2014 11/30/2016 GUNDERSON CLINIC LTD, 420 SOUTH PETERSON AVE, BLAIR, WI 54616
1
12/01/2014 11/30/2016 LA CROSSE CO LAKEVIEW HEALTH CENTER, 902 GARLAND STREET, E, WEST SALEM, WI 54669
1
12/01/2014 11/30/2016 RICHLAND MEDICAL CENTER, 301 EAST 2ND STREET, RICHLAND CENTER, WI 53581
1
12/01/2014 11/30/2016 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 54665
1
12/01/2014 11/30/2016 GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 53821
2
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD, 1830 STATE HWY 9, DECORAH, IA 52101
2
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD, 601 N SUPERIOR, TOMAH, WI 54660
2
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 124 NORTH COURT STREET, SPARTA, WI 54656
2
12/01/2014 11/30/2016 GUNDERSEN LUTHERAN MEDICAL CENTER, 123 - 16TH AVE SOUTH, ONALASKA, WI 54650
2
12/01/2014 11/30/2016 GUNDERSEN LUTHERAN MEDICAL CENTER, 3111 GUNDERSEN DRIVE, ONALASKA, WI 54650
2
1520
Lic #:
GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 11/30/2016 12/01/2014 03/01/1982 (608) 775-6055 (608) 775-6439 [email protected] SARAH MELDE La Crosse County LA CROSSE, WI 54601 1910 SOUTH AVENUE
Service Begin / End Dates
Adm Code
12/01/2014 11/30/2016
CSAS-DAY TREATMENT DHS 75.12
12/01/2014 11/30/2016 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06
12/01/2014 11/30/2016 CSAS-NARCOTIC TREATMENT DHS 75.15
12/01/2014 11/30/2016 CSAS-OUTPATIENT TREATMENT DHS 75.13
12/01/2014 11/30/2016 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
12/01/2014 11/30/2016 MENTAL HEALTH-DAY TREATMENT DHS 61.75
12/01/2014 11/30/2016 MENTAL HEALTH-INPATIENT DHS 61.71
Tier
Branch Location ( s )
Branch Begin / End Dates
12/01/2014 11/30/2016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 124 NORTH COURT STREET, SPARTA, WI 54656
2
12/01/2014 11/30/2016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 123 - 16TH AVENUE SOUTH, ONALASKA, WI 54650
2
12/01/2014 11/30/2016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 18606 ERVIN STREET, WHITEHALL, WI 54773
2
12/01/2014 11/30/2016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 3111 GUNDERSEN DRIVE, ONALASKA, WI 54650
2
12/01/2014 11/30/2016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI 54660
2
12/01/2014 11/30/2016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 53821
1488
Lic #:
LA CROSSE COUNTY HUMAN SERVICES
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 04/30/2016 05/01/2014 02/01/1978 (608) 785-6122 (608) 785-6107 btrussoni@@lacrossecounty.org BEV TRUSSONI La Crosse County LA CROSSE, WI 54601 300 N 4TH STREET
Service Begin / End Dates
Adm Code
05/01/2014 04/30/2016 CSAS-OUTPATIENT TREATMENT DHS 75.13
05/01/2014 04/30/2016 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
05/01/2014 04/30/2016 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35
05/01/2014 04/30/2016 MENTAL HEALTH-EMERGENCY SERVICE 3 DHS 34.3
Tier
Branch Location ( s )
Branch Begin / End Dates
10/01/2015 04/30/2016 RAVENWOOD, 902 GARLAND ST. EAST, WEST SALEM, WI 54669
1
1370
Lic #:
MAYO CLINIC HEALTH SYSTEM - FRANCISCAN HEALTHCARE
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 03/31/2017 04/01/2015 09/01/1977 (608) 392-9736 (608) 392-2647 [email protected] NAN ANDERSON La Crosse County LA CROSSE, WI 54601 700 WEST AVENUE
Service Begin / End Dates
Adm Code
04/01/2015 03/31/2017 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06
04/01/2015 03/31/2017 MENTAL HEALTH-INPATIENT DHS 61.71
NO BRANCH LOCATIONS
1362
Lic #:
MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 05/31/2017 06/01/2015 09/01/1977 (608) 392-9793 (608) 392-9555 [email protected] LACIE ANTHONY La Crosse County LA CROSSE, WI 54601 212 S 11TH STREET
Service Begin / End Dates
Adm Code
06/01/2015 05/31/2017 CSAS-OUTPATIENT TREATMENT DHS 75.13
06/01/2015 05/31/2017 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
06/01/2015 05/31/2017 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 35
06/01/2015 10/04/2015 MENTAL HEALTH-DAY TREATMENT DHS 61.75
Tier
Branch Location ( s )
Branch Begin / End Dates
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - ARCADIA, 464 SOUTH ST JOSEPH AVE, ARCADIA, WI 54612
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 1303 MAIN STREET, HOLMEN, WI 54636
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 54650
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU CH
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - SCARSETH HOUSE, 535 S 17TH STREET, LA CROSSE, WI 54601
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - SIENA HALL, 608 S 11TH STREET, LA CROSSE, WI 54601
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - SPARTA, 310 W. MAIN ST, SPARTA, WI 54656
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - TOMAH, 325 BUTTS AVENUE, TOMAH, WI 54660
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - VILLA SUCCES, 121 PRAIRIE STREET, PRAIRIE DU CHIEN, WI 53821
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN - WOMEN'S LAAR HOUSE, 1005 JACKSON STREET, LA CROSSE, WI 54601
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 700 WEST AVENUE SOUTH, LA CROSSE, WI 54601
2
06/01/2015 05/31/2017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 54601
3005
Lic #:
PEACE OF MIND COUNSELING
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 07/31/2016 08/01/2014 08/01/2013 (608) 797-5679 [email protected] JAY CLARK La Crosse County LA CROSSE, WI 54601
115 - 5TH AVENUE SOUTH, SUITE 507
Service Begin / End Dates
Adm Code
08/01/2014 07/31/2016 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
08/01/2014 02/28/2015 PEACE OF MIND CNSLNG - WINONA MN, 111 MARKET ST, SUITE 4A, WINONA, MN 55987
1
03/01/2015 07/31/2016 PEACE OF MIND CNSLNG - WINONA MN, 902 E. 2ND ST., STE. 322, WINONA, MN 55987
2
08/01/2014 07/31/2016 CENTRAL HIGH SCHOOL, 1801 LOSEY BLVD, LA CROSSE, WI 54601
3
11/12/2014 07/31/2016 COCHRANE-FOUNTAIN CITY SCHOOL DISTRICT, S2770 STATE HIGHWAY 35, FOUNTAIN CITY, WI 5462
3
08/01/2014 07/31/2016 COULEE REGION ALTERNATIVE SCHOOL, 20873 COLLEGE AVENUE, GALESVILLE, WI 54630
3
08/01/2014 07/31/2016 EMERSON ELEMENTARY SCHOOL, 2101 CAMPBELL ROAD, LA CROSSE, WI 54601
3
08/01/2014 07/31/2016 EVERGREEN ELEMENTARY, 510 LONG COULEE ROAD, HOLMEN, WI 54636
3
05/21/2016 07/31/2016 G-E-T ELEMENTARY SCHOOL - GALESVILLE, 17151 FRENCH RD, GALESVILLE, WI 54630
3
08/01/2014 07/31/2016 G-E-T HIGH SCHOOL, 17511 NORTH MAIN ST, GALESVILLE, WI 54630
3
08/01/2014 07/31/2016 G-E-T MIDDLE SCHOOL, 19650 PRAIRIE RIDGE LANE, GALESVILLE, WI 54630
3
08/01/2014 07/31/2016 HAMILTON ELEMENTARY SCHOOL, 1111 SOUTH 7TH STREET, LA CROSSE, WI 54601
3
08/01/2014 07/31/2016 HOLMEN HIGH SCHOOL, 1001 MCHUGH ROAD, HOLMEN, WI 54636
3
08/01/2014 07/31/2016 HOLMEN MIDDLE SCHOOL, 502 N MAIN STREET, HOLMEN, WI 54636
3
08/01/2014 07/31/2016 LA CRESCENT ELEMENTARY, 504 SOUTH OAK STREET, LA CRESCENT, MN 55947
3
08/01/2014 07/31/2016 LA CRESCENT MS/HS, 1301 LANCER BLVD, LA CRESCENT, MN 55947
3
08/01/2014 07/31/2016 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650
3
08/01/2014 07/31/2016 ONALASKA MIDDLE SCHOOL, 711 QUINCY STREET, ONALASKA, WI 54650
3
08/01/2014 07/31/2016 PEACE OF MIND COUNSELING, LLC, 99 MILWAUKEE STREET, LA CROSSE, WI 54603
3
08/01/2014 07/31/2016 PRAIRIE VIEW ELEMENTARY, 1201 NEWPORT LANE, HOLMEN, WI 54636
3
08/01/2014 07/31/2016 SAND LAKE ELEMENTARY, 3600 SAND LAKE ROAD, HOLMEN, WI 54636
3
03/02/2016 07/31/2016 STODDARD ELEMENTARY SCHOOL, 300 N. COTTAGE ST., STODDARD, WI 54658
3
08/01/2014 07/31/2016 VIKING ELEMENTARY, 500 E WALL STREET, HOLMEN, WI 54636
3
3044
Lic #:
WESTERN REGION INTEGRATED CARE CCS
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 06/30/2016 07/01/2015 07/04/2014 (608) 785-6122 (608) 785-6019 [email protected] CHRISTIN SKOLNIK La Crosse County LA CROSSE, WI 54602 300 - 4TH STREET NORTH
Service Begin / End Dates
Adm Code
07/01/2015 06/30/2016 CCS REGIONAL MODEL MULTI-COUNTY DHS 36
Tier
Branch Location ( s )
Branch Begin / End Dates
07/01/2015 06/30/2016 JACKSON COUNTY HUMAN SERVICES - CCS, 420 COUNTY HWY 54 POX 457, BLACK RIVER FALLS, WI
2
07/01/2015 06/30/2016 MONROE COUNTY HUMAN SERVICES CCS, 14301 COUNTY HWY B, SPARTA, WI 54656
3058
Lic #:
WESTERN REGION INTEGRATED CARE CONSORTIUM (WRIC) CSP
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 12/31/2015 01/01/2015 11/01/2014 (608) 785-0002 (608) 785-0001 [email protected] KATHY ROHR La Crosse County LA CROSSE, WI 54601 1707 MAIN STREET
Service Begin / End Dates
Adm Code
01/01/2015 12/31/2015 MENTAL HEALTH-COMMUNITY SUPPORT PROGRAM DHS 63
Tier
Branch Location ( s )
Branch Begin / End Dates
01/01/2015 09/14/2015 FAMILY & CHILDREN'S CENTER, MONROE SITE 2, 14301 COUNTY HIGHWAY B, SPARTA, WI 54656
1
03/16/2015 12/31/2015 FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 221 MAIN ST., STE. L101, BLACK RIVER F
2
01/01/2015 03/15/2015 FAMILY & CHILDREN'S CENTER, JACKSON COUNTY OFFICE, 409 COUNTY RD R, BLACK RIVER FALLS
2
01/01/2015 12/31/2015 FAMILY & CHILDREN'S CENTER, MONROE COUNTY OFFICE, 920 WEST WISCONSIN, SPARTA, WI 5465
2
2280
Lic #:
GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 11/30/2016 12/01/2014 12/01/2000 (608) 775-8661 (608) 775-2287 [email protected] SARAH MELDE La Crosse County ONALASKA, WI 54650 123 - 16TH AVENUE, SOUTH
Service Begin / End Dates
Adm Code
12/01/2014 11/30/2016
CSAS-DAY TREATMENT DHS 75.12
12/01/2014 11/30/2016 MENTAL HEALTH-DAY TREATMENT DHS 61.75
NO BRANCH LOCATIONS
2778
Lic #:
LIVING WELL CHRISTIAN FAMILY CLINIC, LLC
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 03/31/2017 04/01/2015 04/01/2008 (608) 783-1456 (608) 783-1452 [email protected] PHILIP KOESTLER La Crosse County ONALASKA, WI 54650
575 LESTER AVENUE STE #100
Service Begin / End Dates
Adm Code
04/01/2015 03/31/2017 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
NO BRANCH LOCATIONS
2467
Lic #:
STEIN COUNSELING AND CONSULTING SERVICES, LTD
Surveyor: Roderic Senn
Initial Cert: Cert Eff: Cert Exp: Fax: Phone: 08/31/2017 09/01/2015 08/06/2003 (608) 785-7477 (608) 785-7000 [email protected] TED STEIN La Crosse County ONALASKA, WI 54650 571 BRAUND STREET
Service Begin / End Dates
Adm Code
09/01/2015 08/31/2017 MENTAL HEALTH OUTPATIENT CLINIC DHS 35
09/01/2015 08/31/2017 EAGLE BLUFF ELEMENTARY, 200 EAGLE BLUFF COURT, ONALASKA, WI 54650
3
09/01/2015 08/31/2017 NORTHERN HILLS ELEMENTARY, 511 SPRUCE ST, ONALASKA, WI 54650
3
09/01/2015 08/31/2017 ONALASKA HIGH SCHOOL, 700 HILLTOPPER PLACE, ONALASKA, WI 54650