WORK WITH US - BEHAVIORAL HEALTH

Become a Health Plan of Nevada, Sierra Health and Life or Behaviorial Healthcare Options behavorial health provider. Complete the form below and we'll be in touch.

If you are a group, please include a completed Group Roster form. Download the form

* Indicates a required field

    Practice/Group Information

    The Practice or Group Name: field is required
    The Practice Address: field is required.
    The Office Phone: field is required.
    The Tax Identification: field is required
    The Contact Person: field is required
    The Email Address: field is required.
    The Services Provided: field is required
    The Population Served: field is required

    Practitioner Information

    Please complete the below section if you are a sole practitioner, if not, please continue to Count of Clinical

    Count of Clinical

    If you are a group, please include a completed Group Roster form.

    Will you be submitting a Group Roster form?

    Additional Staff Roster Information

    You have completed the letter of interest.
    Once submitted, the review process will be completed within 14 business days.

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