Licensed Independent Practitioners Application

Thank you for your interest in joining Mid-State Health Network. Enclosed is an application for pursuing a contract for servcies, along with related attachments.

If the CMHSP determines a need for services and to pursue a contract, the CMHSP will notify the provider directly. The notification will guide the next steps, including accessing the MDHHS Universal Credentialing system to apply for credentialing approval to provide services. This process requires completion of a credentialing application and submission of documentation. A provider must be credentialed to provide services.

If you have any questions related to the criteria identified above, or questions about completing the application and/or attachments, please feel free to contact us at 517-253-7525.

For your convenience, please click here and download the checklist before continuing.

Please provide an email address where you will recieve an access code that can be use to reload the form and resume progress.