SimpleTherapy

If you are a Behavioral Health provider and you need to change / update your practice information, please use the attached form below. 

Please fill it out completely and include a current / updated W-9 and submit by one of the following ways:

<br>Email: <a href="mailto:provider.relations@simpletherapy.com" target="_blank" rel="nofollow noopener noreferrer">provider.relations@simpletherapy.com</a> 

application/vnd.openxmlformats-officedocument.wordprocessingml.document

BH Provider Infomation Change Form.docx

Change practice information, update, W-9, form

Behavioral Health Provider Information Update Form

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