EXTENDED LISTING

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 mark@tricaredirectories.com or call 512-963-9676.

Facility Name

 Address

Ph #  
Fax #

Email 

 

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
Name  
          ph #
Email  

 

CONTACT PERSON FOR CONTRACTING
Name  
          ph #
Email  

 

Website Address  

 

Other information you would like to include in your listing

 

Sections in which listing is to appear:
(Check all that apply)

Hospitals &
Mental Health
Services
Drug & Alcohol
Treatment
Centers
Residential
Treatment
Centers
Partial
Hospitalization
Hospice & Home
Health
Services
Skilled
Nursing

 
Optional - Please specify other states in which listing is to appear (i.e.: neighboring states).


Check box if your facility is a Tricare Designated Preferred Provider 

 

                    

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