Become A Provider

Step 1:

To begin the process of becoming an approved network provider, complete the provider application by clicking the below link:

Provider Application

Step 2:

Once the provider application has been completed, download the below four forms, complete them, and email them to Finance-Contracts@ceicmh.org

• New Supplier Packet
• Provider Agreement Face Sheet
• Provider EFT Form
• Provider W9 Form