... the workforce solutions company

 

 

Dear Provider,

Thank you for your interest in FEI Behavioral Health, Inc. We are always looking for quality groups and individuals to enhance our network.  Please use this webpage to download our application materials and print this page to use as a checklist. 

If you meet our provider requirements, please download and complete the following forms; which includes a description of our provider requirements, an Affiliate Application and Clinician Profile, a W-9 tax form and optional specialty applications for substance abuse, trauma and workplace training and seminars.  Clinicians that work with organizations that are already FEI affiliates only have to complete a clinician profile and submit resumes and copies of licenses and certifications.

All forms are available in MS-Word Format or Adobe PDF (Get Adobe Reader Free).

 

Form Download and Checklist

Application/Task * Required

MS-Word

PDF

Complete

Application Checklist

Provider Requirements*

Clinician Profile (each clinician must complete)*

Substance Abuse Specialty Application (optional)

Trauma Specialty Application (optional)

Training Specialty Application (optional)

CAQH Provider Data Form  

W-9 Form

Attach Copy of Your Curriculum Vitae or Resume

*(clearly indicating your EAP and specialty experience) *

Please complete as indicated and return to the attention of  the “Network Operations” with the following documentation:   Resumes, professional licenses/certifications and malpractice insurance. Applications can be mailed, faxed or emailed (please include attachments).  Applications must also include a brief description of EAP experience as well as the ability to assess, but not necessarily treat, substance abuse; if not noted in resume.

Should you have any questions about this material, contact us at 800-782-1948 opt. 4 then opt. 3,  or email us @ netops@feinet.com

Again, thank you for your interest in working with FEI and we look forward to hearing from you.

 

Thank you,

 

The FEI Network Operations Department

Network Operations Department

FEI Behavioral Health

11700 West Lake Park Drive

Milwaukee, WI 53224

(800) 782-1948

Fax: (414) 359-1973

netops@feinet.com