Please select the provider type from the list below for application information.
If you have any questions on the information provided for the provider types below, contact Provider Enrollment from 8 a.m. - 4:30 p.m. ET Monday through Friday at (877) 838-5085.
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New Provider Types
Nov. 6, 2014 - Effective Dec. 1, 2014, licensed professional art therapist and applied behavior analyst applications will be accepted. However, these two new provider types will not be allowed to enroll until January 1, 2015.
62 - Licensed Professional Art Therapist
629 - Licensed Professional Art Therapist Group
63 - Applied Behavior Analyst
639 - Applied Behavior Analyst Group