Request for Adult Rehabilitative Mental Health Services (ARMHS) Provider Application
Agency Name
*
Agency Phone
*
This will be the email address that will receive all correspondence from ARMHS
Agency Email
*
Agency NPI
*
Administrative staff that attended the ARMHS Provider Information Session
First Name
*
Last Name
*
Trainlink Unique Key
*
Date Attended
*
Clinical staff that attended the ARMHS Provider Information Session
Same As Admin
First Name
*
Last Name
*
Trainlink Unique Key
*
Date Attended
*