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Integrated Wellness Provider Invoice
This is the only authorized source to submit an invoice for the Mental Wellness Support Program.
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Step
1
of 3
Please select your Company or Organization
*
Please select your business
A. Donald Gerard, MA, CHT - WisdomWork Coaching
A&R Counseling LLC.
Abundance of Hope Counseling Service - Chikeitha Owens M.A LPC
Adiasha Richards, LMHC, LPC|Growth and Transitions Counseling
Adrienne Charleston of Butterfly Flow Counseling, PLLC
Advantage Public Institute (Tamika Carter)
Alissa Young, LCSW | Therapist for College Students
Alphonso Nathan
Amber Boyd, LMFT-Healing Through Authenticity
Angela L. Mull Psychotherapy
Ascent Psychotherapy Center
Aspire Counseling & Wellness Center, PLLC
Aspire Counseling & Wellness Center, PLLC
Astute Mind Therapy & Wellness with Whitney Lawrence-Redden, LCSW
BLACK LOTUS WELLNESS CLINIC @ Life Conscious Energy
Brittany Woodley, The Empowering Space
Chanel McCord, MA, LPC, ACS
CHAT&Change Counseling Services
Child Loss Center Inc. / Dr. Yolanda Fountain Hardy
Chiron Counseling LLC
Christina Harmon Harmony Holistic Healing Center LLC
Circle of Wellness Enterprises LLC
Collins & Collins Counseling Services; Shameka Collins
Collins & Collins Counseling Services; Isaac Collins
Covington-McGee Christian Counseling
Cynthia Chambers MA, LCPC, CGP, CCTP Safe Space Mental Health LLC
Deitra Baker, LMFT
Denise Williams LMFT, Life Curation PLLC
Devin Williams | Resilient Therapy and Solutions
Diona Shelton, LCSW
Donald Willis, Just Call D Counseling
Dr AGW LLC/Culturally Competent Multidirectional Emotional First Aid
Dr. Alicia Delgado-Gavin, Psy.D, Tears Behind the Smile, LLC
Dr. Brittany Peters/ Center for Wellness & Clinical Development
Dr. Cortnie S. Baity, LMFT | Onward and Upward Psychotherapy & Consulting Services, LLC
Dr. Crystal Harper Rosebud LCPC, CTSS
Dr. LaWanda Hill, LLC
Dr. Leeshe Grimes Elevated Minds
Dr. Mia R. Wilson
Dr. Michele Balthrope | Rosemills Counseling and Consulting Services, LLC
Dr. Sandra Miller-Jones, PhD, LPC, NCC; Owner of SunWalk Counseling Services, LLC
Dr. Sarah Williams, LMHT, LPC
Dr. Seleena Smith—REAL Liberation Coaching & Consultation Services
Dr. Sherille D. Barber, PhD, M.Ed., LPCS Barbertherapy & Associates
Dr. Stacy Nakia Peebles, PHD, LCSW
Dyverynce Vaughan Feeling Moody LLC
Ebony Bailey of Life Balance Therapy, LLC
Edify Counseling Group LLC
Emerge Counseling Services
Epiphany Sutton /Refuge Counseling Services
Fightress Aaron, New Beginnings Counseling LLC
Fiona Arthurs, LMFT - The Carlton Center
Francesca Cole-Barnes, LCPC|Faith Changes Behavior
Inklusive Therapy, Racquel Reid (LCSW)
Jacqui Johnson, LPC / Sankofa Healing Studio
Janee V. Henderson, M.Ed., LPC
Janel Holland, LCSW Power for Living Enterprises, LLC
Jason Peace, LCSW|Renewed Strength Counseling Services
Jennifer McClendon Renew Counseling, Consulting, and Wellness Services
Jewrine Brown, LCMHC, NPP, CTMH, THTC, CCATP
Just Be Therapeutic Services, Sheniqua Dones-Wallace LMHC, NCC
Kamilah Matthew, Deeply Rooted Therapy LCSW
Kamilah Thomas
Keisha Cox, LCSW
Kellee Barrett, LCSW - KB's Lighthouse Counseling Services
Keyona Aviles, LMHC ~ Inspired Release
Kimani Norrington-Sands, Ph.D., Lifting As We Climb Consulting
Kimberly Ann Parker, Revive to Thrive Wellness, PLLC
Krista Woods, M.S.W., LCSW
Kristian A. Holmes, LMHC-QS, CST, NCC, Ed.S
LaBrenda Thomas, LCSW, LSSW
LaMora Pace, LCSW, CAP | The Healing Crest Counseling Services, LLC
LaPrincess Foster, LPC / Kesi Therapy and Holistic Arts
Lathosha Alexander, MSW, LCSW, CPC Healthy Minds Healthy Hearts Therapeutic Services, LLC
Ledora Yerks, M.Ed., LPC, NCC - Motivate Wellness Behavioral & Relationship Health Services, LLC
Leticia Berg Psychotherapy
Life Connections- Niesha Davis, LCSW, CAMS-II
Look Within Counseling, LLC
Melissa Comeau, Ed.S., LMHC, LMFT, NCC, Relationship Expert, Heartfelt Counseling Center, LLC
Mellisa Gooden, LMFT, LMHC, MA | A Good Place For Help
Metamorphosis ,LMSW P.C. & Wellness Center
Michaela Ramos, MSE, LPC, NCC
Michelle Bee
Mindful Wellness Reset: Relax, Release & Renew, PLLC
MLC Consulting, LLC
Nadia Gaynor | New Life Goals
Niki Evans-Hook, LCMHCA|Renewed Strength Counseling Services
Omolola Taiwo, NCC, LPC
Pamela Moore-Jones, LCSW
Paradise Therapeutic Services
Pearls of Change Wellness, LLC
Petrina L. Williams LICSW, LCSW-C Miracles In Motion Therapy and Consulting LLC
Phylicia Massey, QSW,LCSW
Poiab Vue, LICSW (Life Curation, PLLC)
Rachel Johnson, Half Hood Half Holistic LLC
Rashan Carter, LCSW, Passion & Purpose Fulfilled
Refuge Counseling Services
Renee Hodgins of Renee Hodgins, M.Ed., LPC | Counseling & Educational Center, LLC
Renee Manneh | Renewed Strength Counseling Services
Royal People Group| Mountain Retreats & Iridology with Naturopathic Doctor, Roxanne Simone Lord
S.M.A.R.T. Girl, Incorporated
Scenic City Therapy, LLC.
Shaena Wiggins, LCSW/ Transformative Therapeutic Services, LLC
Shawnnell Batiste, LPC *TX
Strength, Love, and Motivation, LLC - Amanda Davis-Buie, MS, LPC, LBS, NCC
Synchronicity, LLC/Be Well
Tamara White MA, LPC, CRC|OCVR-Care LLC
Tiffany Rowland, LCSW - Right Choice Therapy, LLC
TS Therapy Group
The WHOLE-Self Healing Institute, Inc.
Transcend Clinical Services, Inc
Twanna Carter, JBC Counseling & Consulting, LLC
Victoria Griffin, LPC- Resiliency Counseling, LLC
Wendy Donald, LMHC Oasis for Wellness Counseling
Yeshiva D. Davis, — LMFT, MBA K&S Therapeutic Services, Inc.
Address
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Address Line 1
Address Line 2
City
--- Select state ---
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Alaska
Arizona
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California
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District of Columbia
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Illinois
Indiana
Iowa
Kansas
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Maine
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Michigan
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Tennessee
Texas
Utah
Vermont
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Washington
West Virginia
Wisconsin
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State
Zip Code
Email
*
Phone
*
Next
Provider Name
*
First
Last
Integrated Wellness Hangout
Visit Date / Time
*
Date
Time
Name(s) of All Group Attendees
*
Please Upload Any Sign-In Sheets, Contracts, etc.
Click or drag files to this area to upload.
You can upload up to 10 files.
Visit CPT Code
*
90853: Group psychotherapy
90849: Multiple-family group psychotherapy by physician directed
Other
Other CPT Code
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Billable Charge
*
Group with 1-14 Attendees - $150.00
Group with +15 Attendees - $300.00
I accept the universal flat rate per session.
Payment Choice
*
Direct Deposit (ACH Transfer) - 14 business day processing
The person submitting this invoice is the owner or an authorized agent.
*
Owner / Provider
Authorized Agent
Authorized Agent's Name and Title
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