Contact Information

  • Provided by the National Council for Mental Wellbeing and SAMHSA, this is an opportunity for CCBHC grantees to apply and participate in direct consultation with MTM Services for Data Mapping and/or Collaborative Documentation. This a 5-6 month commitment.
  • Completion of this application indicates that the organization is committed to participating in this opportunity, if selected.
  • Lack of attendance/participation may result in cancellation of an organization’s acceptance.
  • Grantees chosen to participate will receive these services free of charge to their organization, sponsored by the CCBHC-E National Training and Technical Assistance Center.

Applications will be accepted through Monday, April 7, 2025

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* 1. This application is for the following consultation options: (Check one or more)

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* 2. What is your CCBHC Status?

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* 3. Please enter your demographic information

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* 4. Please enter the following information about the Executive Director / CEO on your team.

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* 5. Please enter the following information about the COO on your team.

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* 6. Please enter the following information about the CFO on your team.

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* 7. Please enter the following information about the Quality Improvement / Utilization Management leader on your team.

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* 8. Additional stakeholders.

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* 9. Additional stakeholders.

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