08/31/2020 While every effort is made to ensure accuracy of the provider information in this directory, the status of providers may change over time. Some network providers may have been added or removed from our network after this directory was printed. In the event a provider is no longer with an office when you call, please ask the office if there are other participating providers at that location who treat members under 6 years of age. For further assistance, you may call Member Services at 1-800-941-4647 (TTY: 711). Table of Contents Acute Partial Hospitalization Mental Health/Psychiatric Partial Hospitalization....................................................................................4 Adult Mental Health Rehabilitation (AMHR).......................................................................................................................................11 Ambulatory withdrawal management with extended on-site monitoring/Ambulatory Detoxification ASAM 2-WM..............................16 Applied Behavioral Analysis...............................................................................................................................................................18 Independent Practitioner(s): NP Psychiatric MH................................................................................................................................21 Independent Practitioner(s): Psychiatry; Neurology (Osteopaths Only).............................................................................................45 Independent Practitioner(s): Psychologist.........................................................................................................................................83. Inpatient Medical Detox/Medically Managed Inpatient Withdrawal Management (hospital) ASAM 4-WM.......................................149. Inpatient Psychiatric Hospital Care..................................................................................................................................................150 Medication Monitoring......................................................................................................................................................................155 Non-Medical Detoxification/Non-Hospital based withdrawal management ASAM 3.7 –WM............................................................219 Opioid Treatment Services (Methadone Maintenance)....................................................................................................................220 Opioid Treatment Services (Non -Methadone Maintenance)...........................................................................................................222 Outpatient Mental Health Hospital Clinic.........................................................................................................................................224. Outpatient Mental Health Independent Clinic..................................................................................................................................226. Partial Care Mental Health...............................................................................................................................................................242 Substance Use Disorder Intensive Outpatient (IOP) ASAM 2.1......................................................................................................255. Substance Use Disorder Long Term Residential (LTR) ASAM 3.5..................................................................................................263 Substance Use Disorder Outpatient (OP) ASAM 1..........................................................................................................................265 Substance Use Disorder Partial Care (PC) ASAM 2.5.....................................................................................................................272 Substance Use Disorder Short Term Residential (STR) ASAM 3.7.................................................................................................