Medicare Enrollment Preference Form (LPCs and LMFTs)

Medicare Enrollment Preference Form

Complete this form if you would like to enroll with Medicare Credentialing
Please note: Grow does not currently allow providers to bill directly with Medicare or Medicaid. Instead, we work with Managed Care plans, which require separate enrollment processes from the state. If you choose to enroll with and see Medicare or Medicaid clients below, we will automatically enroll you with the Managed Care plans available in your licensed state(s).
Email*
Please enter your email on file with Grow Therapy
Legal Name*

First NameLast Name
Would you like to enroll with and see Medicare clients?*

YesNo
Please upload your Diploma or Degree for your highest level of education. *

Cancelof
Medicare Interest Form (LPCs/LMFTs)
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