Fill in all that apply & click on "submit" button at bottom of
form. You will be billed once your listing is added to TricareDirectories.com.
For listing fee information, email
or call 512-963-9676.
SPECIALTY PROGRAMS - (Eating Disorder Program, Closed
Door Facility, Sexual Dysfunction Treatment, etc.)
DIAGNOSES TREATED - (list primary diagnoses treated,
especially unusual diagnoses.)
CONTACT PERSON FOR ADMISSIONS
CONTACT PERSON FOR CONTRACTING
Other information you would like to include in your
Sections in which listing is to appear:
(Check all that apply)
Optional - Please specify other states in which listing is to appear (i.e.:
Check box if your facility is a Tricare Designated Preferred Provider