Licensed Independent Practitioners Application

Thank you for your interest in joining Community Mental Health for Central Michigan's Provider Network.

The following qualifications must be demonstrated in your application materials in order for us to accept your application:

  • License: A current unrestricted, unconditional license to practice mental health and/or substance use disorder services in the State of Michigan.
  • Certification (if applicable): Current certifications to provide specialized services as required by the State of Michigan.
  • Board Certification (applies to physicians).
  • Insurance: Current malpractice insurance and professional liability insurance in the amount required by MSHN (minimum $1,000,000 per occurrence and $3,000,000 aggregate).
  • Enrollment in CHAMPS

The application must be completed in one session, and progress will not be saved. For your convenience, please click HERE and download the checklist before continuing.

If you have any questions related to the criteria identified above, or questions about completing the application and/or attachments, please feel free to contact me at (989) 772-5938.

Thank you,
Katherine Squire
Provider Network Manager
Community Mental Health for Central Michigan

"Nurses, doctors, and case managers working together to help me with resources and working strongly to help me overcome the loss of my marriage"
-Osceola County