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Mental Wellness Invoice Portal 2023
Mental Wellness Support Program Invoice 2023
This is the only authorized source to submit an invoice for the Mental Wellness Support Program.
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
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Step
1
of 3
Please select Client's Program
*
Mental Wellness Support Program RD1 (150 Black Men)
Release Trauma Mental Wellness
Women's Mental Wellness Program
Senior Citizen's Wellness Program
SAG-AFTRA Wellness Program
Duke Ellington Wellness Program
Middle East Conflict Mental Wellness Emergency Program
Holiday Blues Wellness Program
Please select your Company or Organization
*
Please select your business
A. Donald Gerard, MA, CHT - WisdomWork Coaching
A&R Counseling LLC.
Abe Turner, MA, LPC-A | The Weekend Therapist
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)
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
Calvary De'Rosa Counseling and Consulting
Candice Coulter, LCMHC|A Child’s Perspective Child and Adolescent Counseling Services
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
Dea Lott|DivineSense
Deitra Baker, LMFT
Demetryas Pennegraph, MS-Mental Health Counseling- R.E.A.L. Wellness (Restoring, Educating And Leading)
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. Lisa Pittman - LePiatz Psychology, LLC
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
Eboni S. Williams, MA, LPCC
Ebony Bailey of Life Balance Therapy, LLC
Edify Counseling Group LLC
Emerge Counseling Services
Epiphany Sutton /Refuge Counseling Services
Erica Tatum-Sheade, LCSW
Fightress Aaron, New Beginnings Counseling LLC
Fiona Arthurs, LMFT - The Carlton Center
Focused Behavioral Interventions, LLC
Francesca Cole-Barnes, LCPC|Faith Changes Behavior
Inklusive Therapy, Racquel Reid (LCSW)
Jacqui Johnson, LPC / Sankofa Healing Studio
Jamie Kirk/ JK Family Therapy, Inc
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
Kayla Harley | Founder of The Beebodi Marketplace, Holistic Wellness Practitioner, Breathworker & Somatic Movement Therapist
Keisha Cox, LCSW
Kellee Barrett, LCSW - KB's Lighthouse Counseling Services
Kevin Muhammad, LCSW
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
Lakisha Foxworth, LMFT
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. Cheryl Mchunguzi ,LMSW RMT
Michaela Ramos, MSE, LPC, NCC
Michelle Bee
Mindful Wellness Reset: Relax, Release & Renew, PLLC
MLC Consulting, LLC
Nadia Gaynor | New Life Goals
Nia J. Henderson MA, LMFT
Niki Evans-Hook, LCMHCA|Renewed Strength Counseling Services
Omolola Taiwo, NCC, LPC
Pamela Moore-Jones, LCSW
Patrice Brantley of Patrice Brantley, LMHC|Seed Sowing Sistah Movement, LLC
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
Pieces of Me Behavioral Health, LLC
Poiab Vue, LICSW (Life Curation, PLLC)
Rachel Johnson, Half Hood Half Holistic LLC
Rashan Carter, LCSW, Passion & Purpose Fulfilled
Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
Refuge Counseling Services
Renee Hodgins of Renee Hodgins, M.Ed., LPC | Counseling & Educational Center, LLC
Renee Manneh | Renewed Strength Counseling Services
S.M.A.R.T. Girl, Incorporated
Scenic City Therapy, LLC.
Shades of Resilience Counseling
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
The MECCA Group, LLC
The WHOLE-Self Healing Institute, Inc.
Therapy for Black Women |Jerisha LaCrae, M.Ed, LPC, LPCC, NCC
Tiffany Rowland, LCSW - Right Choice Therapy, LLC
TS Therapy Group
Transcend Clinical Services, Inc
Twanna Carter, JBC Counseling & Consulting, LLC
Victoria Griffin, LPC- Resiliency Counseling, LLC
Wendy Donald, LMHC Oasis for Wellness Counseling
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Maine
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Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
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Phone
*
Next
Service Provider
Provider Name
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First
Last
Client
Client Name
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First
Last
Client Number
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Client Session Number
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1st session
2nd session
3rd session
4th session
5th session
Visit Date / Time
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Date
Time
Visit CPT Code
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90836: Forty-five minutes of individual psychotherapy performed with an E/M service
90837: Sixty minutes of individual psychotherapy
90838: Sixty minutes of individual psychotherapy performed with an E/M service
90847: Family psychotherapy with the patient present
90846: Family psychotherapy without the patient present
Other
Other CPT Code
Is this invoice for the final session?
*
Yes
No
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Billable Charge
*
Universal Flat Rate - $150.00
I accept the universal flat rate per session.
Payment Choice
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Direct Deposit (ACH Transfer) - 14 business day processing
Name on Account
The person submitting this invoice is the owner or an authorized agent.
*
Owner / Provider
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Authorized Agent's Name and Title
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