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IL New Clinician

IL - New Clinician Hire

Licenses
License Type
License Number
License Issue Date
License Exp Date
 

Credentialing

Our National Credentialing Team will be managing your credentialing process at LifeStance! The team will keep your CAQH account updated, complete any required attestations and submit all applications to our over 90+ different insurances on your behalf. Many of our insurance payors have allowed us to panel our under-licensed clinicians (LPC/LSW/AMFT) so we ask all of our providers, licensed at any level, to complete all requested information sections in this form and complete the Credentialing Authorization Form sent to you through DocuSign separately.
To retrieve your login information, visit https://proview.caqh.org/Login/Index?ReturnUrl=%2f or call CAQH support at 1-888-599-1771 To create a new account: https://proview.caqh.org/PR/Registration

Getting to Know

We want our intake team to have the most accurate picture of who you are so we can make the BEST clinical matches for you and keep you as productive and filled up with clients as you desire to be. Please provide the below info regarding client populations you serve.
Patient Ages Treated(Required)
Check all you are comfortable taking referrals for:
Areas of Treatment (select all that apply)(Required)
This list is used by intake to filter available therapists in the matching process. For issues you don’t select, a client that calls with that presenting issue will NOT be placed with you.
Drop files here or
Accepted file types: pdf, jpeg, png, Max. file size: 300 MB.
    Drop files here or
    Accepted file types: pdf, jpeg, png, Max. file size: 300 MB.