Add/Edit Listings

Complete this form to submit changes to a current listing or submit a new listing. If you are submitting an edit, you may complete only the section that needs to be updated and we will replace your current listing with the new information.




Your personal information will not be shared with outside individuals and will only be used if further clarification is needed re: any information you have provided.



Please indicate the populations your services are specifically designed for.

Please indicate the types of payment that are accepted.

  Expanded Medicaid:
  Private Insurers:

Please check all services and sub-types offered.

  WM type:

Outpatient Counseling

  Outpatient Counseling type:

  Specific medication:

  RSS type:

  Primary care service setting:

Please share any comments you may have related to the edits or new listing you have submitted.

Edits/new listings will be updated within two weeks of a submitted request.