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Contracting Behavioral Health Service Extenders

LMSW, LPC, LAMFT, Licensed Psychologist Extender

  1. 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)

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Fax:  208-387-6818


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