Join Our Network

First Name*
Last Name*
Practice Name*
Office Address*
Office City*
Office State*
Office Zip Code*
Office County*
Email*
Phone*
License Type (check all that apply)*
- Acupuncturist (OR only)
- Applied Behavioral Analyst
- Chiropractor (OR only)
- Massage Therapist
- Masters Licensed Therapist
- Naturopath
- Physician Assistant
- Psych Nurse Practitioner
- Psychiatrist
- Psychologist
States Licensed to Practice*
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
- Armed Forces Americas
- Armed Forces Europe
- Armed Forces Pacific
What type of network(s) is of interest to you?*
- CAM/PAM Alternative Medicine (OR only)
- DOT Substance Abuse Assessments
- Employee Assistance Programs (EAP)
- Fitness for Duty
- Health Professional Services Program (DE, OR only)
- Managed Behavioral Health Plans
- Telehealth