Phone: 800-333-6228
TT/TTY: 800-745-5555

LifeWatch Employee Assistance Program
TT/TTY 1-800-745-5555

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Provider Applications

Dear Potential Provider for LifeWatch EAP:
The following are individual and agency provider applications and attachments that will need to be filled out before becoming a provider for LifeWatch. These applications may be filled out online and e-mailed back to me by saving the file and attaching it to an email. However, you will still need to send us your resume, and any copies of ceu's if applicable.
If you have any questions, please do not hesitate to call me at 1-800-333-6228 or
Mary F. Cimini 

You will need Adobe Acrobat Reader to view these files.If you do not have it, you can download it here.

Agency Provider Application
Individual Provider Application