Request to Join Our Network

Provider Form

Thank you for your interest in joining our Network!

Please fill out the form below so that we may begin your credentialing process. All providers must have a currently attested CAQH application to begin the credentialing process with First Choice Health. If your CAQH application is not current, DO NOT complete this form until it is current.

Please DO NOT complete this form if you are not in one of our service areas. We only do business in the following states: Alaska, Idaho, Oregon, Washington, and Big Sky Region (MT, WY, SD, ND, NE, CO, UT)

Network Closures

Washington (excludes Clark County)

We are not accepting applications for Licensed Massage Therapists or Acupuncturists.

  • Clark County Licensed Massage Therapists and Acupuncture providers contact Axis Healthcare for credentialing and contracting information by email [email protected] or by phone (505) 245-4100.

Oregon (includes Clark County)

Mental health provider types in Oregon and Clark County, Washington, please contact LifeStance Health for credentialing and contracting information by emailing [email protected] or by phone (253) 346-0397.

Complementary and Alternative Medicine (Chiropractors, Naturopaths, Massage Therapists and Acupuncturists) please contact Axis Healthcare for credentialing and contracting information by email [email protected] or by phone (505) 245-4100.

If you are an RN Only or an Associate level counselor, we do not contract or credential you. PLEASE DO NOT PROCEED.

If you are unsure, please review the specialty list.

Please Note:

FCHN does not contract/credential in the state of . Contact Provider Relations at [email protected] for more information

Primary Location
A Hospital-based provider is a provider whose services are performed physically within, connected to a hospital, or on a hospital campus, and are legally associated with a hospital. Please contact [email protected] to learn how to add a Hospital-Based location to your record.
Credentialing Office