Becoming an ESI Employee Assistance
Group Service Provider
Mandatory Requirements
- State Licensure as a Behavioral Health Professional with a minimum of 5 years post-master’s experience.
- We are currently not empaneling Nurse Practitioners, Physician’s Assistants or Psychiatrists.
- 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]
Please review and fill out the following for SMS Texting (not required to be a Provider)
[SMS Texting Terms and Conditions]
[Texting Letter PDF]
[Texting Letter Word Doc]
Service Provider Application Form and include:
- Professional Malpractice Liability Insurance Face Sheet
- State Licensure or Registration with Expiration Date
- Resume
- W9 Tax ID Form
Please return completed application with supporting documentation to our Corporate
Office: ESI Employee Assistance Group
E-mail: providers@theEAP.com
Fax: 585-593-6311
Provider Information
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.