ALL FRPN SERVICES ARE 100% CONFIDENTIAL*

Standardized exceptions should be discussed with your provider.

(765) THE-FRPN

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Find A Provider

Provider Application

Incomplete applications will not be processed. Questions with an asterisk* are required. 

Psychiatrists: Must have a permanent Missouri licensure from the Board of Healing Arts.

Therapists: Must be licensed to practice counseling or social work in the State of Missouri.

Full Name *
Business Name *
Business Phone *
Business Email *
Business Website
Office Hours *
Address *
 Suite #
 City *
State *
Zip Code *
Personal Phone *
Personal Email *
Bio *
1500 character limit.
Have you ever done a ride-a-long with a first responder? *
Have you ever been a first responder yourself? *
Do you have any first responders in your family? *
Do you currently see first responders, their children or spouses of first responders?
Credentials *
If Other, Please List Other Credentials
Sex *
Race *
Religious Affiliation *
Ages Served *
Service *
In Person or Telehealth *
Check all that apply.
Treatment *
Expertise *
Other Areas of Expertise *
Cash? *
Pro-Bono? *
Sliding Scale? *
Insurance *
Profile Image
Maximum file size: 25 MB
Please upload your profile image. This image will be displayed publicly on your profile.
Upload Resume *
Maximum file size: 25 MB
Terms & Conditions *
I acknowledge and agree to the following terms regarding my potential acceptance as a provider within the First Responder Provider Network (FRPN):

Individual Membership Only
Acceptance into the FRPN applies solely to me as an individual provider.
My acceptance does not extend to my practice, group, or any other clinicians with whom I work.
Any partners, associates, or additional clinicians in my office who wish to participate in the FRPN must submit their own application and be accepted as individual members.

Referral Responsibility
I understand and agree that any referrals I receive from the FRPN are to be seen only by me, as the credentialed provider.
Referrals from the FRPN may not be reassigned, delegated, or referred to any provider who is not an accepted member of the FRPN.

Compliance
I understand that failure to comply with these requirements may result in suspension or removal from the FRPN.