Add Your Organization to the IBH Resource Map Please enable JavaScript in your browser to complete this form.Organization/ Provider Name *Contact Name *FirstLastEmail *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Service Platforms Offered *TelehealthPhoneIn-PersonIs Your Clinic PCBH integrated?YesNoI would like more information about PCBH integrationWhat Services do You Offer? *What Insurance Providers Does Your Organization Accept?Website / URLIs There an Intake Process to Receive BH Services (Either Remotely or In-Person)?Pleease include if BH Services are Available Only to Patients of Your Specific System/OrganizationAre You Accepting New Patients?YesNoAre There Bilingual or Spanish Speaking Providers/Services Available?YesNoSubmit Anthony LeonAdd Your Organization to the IBH Resource Map09.25.2020