Get New Directions Behavioral Health

Filling out the New Directions Behavioral Health form online can streamline your application process and enhance your chances of being considered for the panel. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the online form.

1. Click the ‘Get Form’ button to access the document and open it in your preferred digital platform.
2. Begin by entering your name in the designated field at the top of the form.
3. Next, provide your National Provider Identifier (NPI) in the appropriate space.
4. Fill in your CAQH number and Tax Identification Number (TIN) to ensure proper identification.
5. Complete your office address, making sure to include the city and zip code.
6. Record your office phone number and office fax number for communication purposes.
7. Enter your email address, ensuring it is active and you have access to it.
8. In the licensure section, indicate your license types and states by selecting the relevant options.
9. Circle your credentials from the list provided to confirm your qualifications.
10. If you are a physician, indicate whether you are board certified or board eligible.
11. Provide your DEA number if applicable, and complete the coursework and experience sections.
12. Check the areas of generally covered services where you have been trained and are experienced.
13. Indicate any special populations you work with by checking the relevant boxes.
14. Confirm whether your office is handicap accessible and if you offer in-home visits.
15. Specify the age groups you work with and, optionally, your racial or ethnic heritage.
16. Lastly, fill in your available hours for seeing patients from Monday to Sunday.
17. Once completed, save your changes and choose to download, print, or share the form as needed.

Begin filling out the New Directions Behavioral Health form online today to facilitate your application process.