Specialty Mental Health Services Provider Certification and Recertification
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10-04: MHP Self-certification Letter.pdf
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DHCS 1735 Medi-Cal Certification Transmittal Form | Kev cob qhia Video
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County-owned and operated provider – activate mode(s) or service, termination of a mode(s) or all services, address change and name change.
Contracted provider – activate a new provider, activate a mode(s) of service, and terminate mode(s) or all services, recertification, address change and name change.
DHCS 1736 County-Owned and Operated Certification Daim Ntawv Thov | Kev cob qhia Video
The purpose of the form is for the County to submit an application for a new county-owned and operated provider.
DHCS 1737 County-Owned and Operated Provider Self-Survey Form | Training Video
The purpose of the Self-Survey Form is for the recertification of a county-owned and operated provider.
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1500 Capitol Avenue, MS 2303
PO Box 997413
Sacramento, CA 95899-7413
Email: DMHCertification@dhcs.ca.gov