Psychotherapy - Individual or Group

You must have one of the following licenses to provide this service:

  • Licensed Clinical Psychologist
  • Licensed Clinical Social Worker
  • Licensed Marriage or Family Therapist
  • Licensed Clinical Professional Counselor

How Do I Become A Provider?

  1. Obtain a National Provider Identifier from the National Plan and Provider Enumeration System. 
    1. The NPI must be a Type 1- Individual.
    2. The taxonomy code must align with your license and the services that will be provided.
  2. Send a copy of your current license to: .
  3. Submit an IMPACT provider enrollment application to enroll as a Developmental Disabilities Medicaid Waiver Provider.
    1. Create an IMPACT account on the IMPACT login page.  Please use the Single Sign-On ID PowerPoint Presentation found on the IMPACT Presentations and Materials page on the HFS website to complete this step. 
    2. When the Single Sign-On ID has been approved, return to the IMPACT login page and log into your account. There will be a blue IMPACT hyperlink located on the IMPACT home page under the 4 green boxes.  Click on the IMPACT hyperlink to access the IMPACT Provider Enrollment System. 
    3. Click on NEW ENROLLMENT.  On the next screen, select the Enrollment Type: 
      • Individual/Sole Proprietor
      • Regular Individual/Sole Proprietor or Rendering/Servicing Provider
    4. On the Basic information page, select the Applicant Type based on the definitions of Independent Sole Proprietor or Rending/Servicing Provider listed below Click on the applicant type links for further instructions.
      • Independent Sole Proprietor - A person that works independently and renders direct services to persons enrolled in the Developmental Disability Medicaid Waiver program.  Note:  This does NOT include persons that are the sole member of a LLC or owns and operates an incorporate business.
      • Rendering/Servicing Provider - A person that renders services in the Developmental Disability Medicaid Waiver program as an employee or contracted provider for company or provider group
  4. Send an email to to notify DHS, Division of Developmental Disabilities that your application has been submitted for state review. 

Important Resources for Program Requirements