Military Services
Network Provider Interest Form
Who this is for
Eligible providers are independently licensed behavioral health clinicians with military cultural competency and demonstrated experience and delivery of evidence based treatment such as BCBT-SP, CPT, EMDR, or PE.
What to expect
After you submit this form, our team will review your information. If we have a current or upcoming opportunity in a state in which you are licensed, we will reach out to you directly. Important Note: This is an interest form only.
Provider Information
Complete all required fields below. Independent licensure is required.
Thank you for your interest in connecting with our program. Please complete this form to indicate your interest and our team will be in touch soon.
