Professional Experience Survey & Contact Information

If interested in learning more about becoming a CANS Certified Provider within the Louisiana Coordinated System of Care (CSoC), please complete our brief Professional Experience Survey & Contact Information.

First Name

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* 1. First Name

Middle Initial

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* 2. Middle Initial

Last Name

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* 3. Last Name

Job Title

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* 4. Job Title

Name of Employer

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* 5. Name of Employer

Email Address

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* 6. Email Address

Phone Number

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* 7. Phone Number

Parish(s) covered in professional work

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* 8. Parish(s) covered in professional work

Are you licensed?

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* 9. Are you licensed?

Do you currently provide any contracted service with Magellan Health Services / LA Behavioral Health Partnership (LBHP), either independently, group practice or through an organization?

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* 10. Do you currently provide any contracted service with Magellan Health Services / LA Behavioral Health Partnership (LBHP), either independently, group practice or through an organization?

Do you currently provide CANS assessments outside of the Coordinated System of Care (CSoC)?

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* 11. Do you currently provide CANS assessments outside of the Coordinated System of Care (CSoC)?

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