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Directory Results for BEHAVIORAL HEALTH AGENCY REQUEST FOR INATION Date: Patient's name: MID: DOB: This patient is currently receiving Behavioral Health Services at our agency and lists your practice as his/her primary care provider - ncdhhs to Behavioral Health Agency Voluntary Agency or Service Cancellation Request . A four page application that Behavioral Health Agencies in Washington State complete when they are closing part or all of their agency.

BEHAVIORAL HEALTH AGENCY REQUEST FOR INATION Date: Patient's name: MID: DOB: This patient is currently receiving Behavioral Health Services at our agency and lists your practice as his/her primary care provider - ncdhhs
Behavioral Health Agency Voluntary Agency or Service Cancellation Request . A four page application that Behavioral Health Agencies in Washington State complete when they are closing part or all of their agency.