Becoming an ESI Employee Assistance
Group Service Provider
- State Licensure as a Behavioral Health Professional with at least a Master’s Degree.
- Minimum and current Malpractice Liability Insurance Coverage of $1 million /$3 million
- Empanelment with at least one major/area Behavioral Health Insurance plan.
Please complete and sign the Provider Application
[Click Here to Fill Out the Provider Application]
Service Provider Application Form and include:
- Professional Malpractice Liability Insurance Face Sheet
- State Licensure or Registration with Expiration Date
- W9 Tax ID Form
Please return completed application with supporting documentation to our Corporate
Office: ESI Employee Assistance Group
If you are a licensed counselor that would like to become a contracted provider for ESI Employee Assistance Group, please complete the following form for recommendation. Our Network Development Specialist will get in touch with you about contracting with ESI.