We invite you to join our EAP network.If you're interested in helping empower members to lead healthier and more productive lives, please apply to join our Employee Assistance Program network.
Before you begin your application, please collect the following items:
- NPI/Tax ID
- Copy of your Professional License
- Copy of your Certificate of Insurance
- Copy of your current W-9
- Copy of your current resume
You can upload these materials directly to the application to expedite processing. However, if you need to fax your materials, the number is located on the application.
Click here to begin your application.
We understand you’re busy. If you need to save your application and complete it at a later time, please follow these instructions:
Need to save and complete later?
- Click Save my progress and resume later in either the upper or lower right hand corner of the application
- Enter your email address and create a password
- Confirm password
- Click Save
Resume your applicationWhen you’re ready to complete your application, please follow these instructions:
- Return to Complete My Application
- Click Resume a previously saved form in either the upper or lower right hand corner of the application
- Click OK
- Click Leave this page
- Enter your email address and the password you created when you saved your application
- Click Resume this form