Contracting Behavioral Health Service Extenders
LMSW, LPC, LAMFT, Licensed Psychologist Extender
- Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.
- Current state license (attach a copy)
- Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
- Provider information sheet
NOTE: LMSW, LPC or LAMFT may be covered if supervised by a physician, psychologist, LCPC, LMFT or LCSW.
Contact your Provider Relations Representative if you have questions . (See PAP100)