SAMHIN Providers: submit this form to notify us of any changes in your provider directory listing information. We will make every effort to update your listing within one week.
If you would like to apply to be listed in our Provider Directory, please complete the Provider Registration form.
Note: The email field is for SAMHIN use only to contact you – it will not display on your provider directory listing. If you would like to display your email, please enter it in the Practice Description section.
By completing this form, you grant SAMHIN permission to publish your information on our website.
Required fields are noted with a *