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NORTH DAKOTA MEDICAID ENROLLMENT ATTESTATION FOR BEHAVIOR MODIFICATION SPECIALIST Practitioner Name (printed)NPI As a Behavior Modification Specialist (BMS) enrolling to provide services under the
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How to fill out behavioral health certificate
How to fill out behavioral health certificate
01
Obtain a copy of the behavioral health certificate form from the relevant authority or organization.
02
Fill out the personal information section including your name, address, and contact details.
03
Provide information about your education and training in the field of behavioral health.
04
List any certifications or licenses you hold related to behavioral health.
05
Include information about any relevant work experience in the behavioral health field.
06
Sign and date the certificate form to certify that the information provided is accurate.
Who needs behavioral health certificate?
01
Individuals working in the field of behavioral health who need to demonstrate their qualifications and experience.
02
Employers or organizations requiring proof of certification or training in behavioral health.
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What is behavioral health certificate?
Behavioral health certificate is a document certifying that an individual has completed training in behavioral health and is qualified to provide related services.
Who is required to file behavioral health certificate?
Behavioral health professionals such as counselors, therapists, and social workers are required to file a behavioral health certificate.
How to fill out behavioral health certificate?
To fill out a behavioral health certificate, one must provide their personal information, details of their training or certification, and any relevant work experience.
What is the purpose of behavioral health certificate?
The purpose of a behavioral health certificate is to ensure that professionals in the field have the necessary training and qualifications to provide effective services.
What information must be reported on behavioral health certificate?
The behavioral health certificate must include the individual's name, training or certification details, work experience, and any relevant licenses or credentials.
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