Get Teladoc Behavioral Health Credentialing Application

Filling out the Teladoc behavioral health credentialing application can be a straightforward process if you follow the right steps. This guide provides clear and detailed instructions on how to complete each section of the application online.

Follow the steps to successfully complete your credentialing application.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling out the personal and practice information section. This includes your name, citizenship status, social security number, place of birth, and specialty. Be sure to include accurate contact information such as your home address, phone numbers, and email.
3. Provide your National Provider Identifier (NPI) number and Medicare number. If applicable, indicate your Medicaid registration status, and include any Medicaid registration numbers along with the states.
4. Detail your education and training. Include the name of the institution, address, degree, major, and dates of attendance. You must confirm whether each program was successfully completed.
5. List your professional licenses and certifications. For each license, include the state of licensure, license number, type, and effective dates.
6. Provide your work history. Document at least five years of your professional experience, including your current employer, job title, phone number, dates of affiliation, and supervisor's contact information.
7. Answer all professional questions thoroughly. Ensure you respond with 'Yes' or 'No' and provide additional documentation or explanation for any 'Yes' responses.
8. Complete the authorization, attestation, and release form at the end of the application. Affirm the accuracy of your information and consent to the sharing of relevant details for credentialing purposes.
9. Review the entire application for completeness and accuracy. Make sure that all required documents are attached, and correct any errors before submission.
10. Once completed, save your changes. You can then download, print, or share the application as necessary.

Complete your credentialing application online today and take the next step in your professional journey.