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... Suite 100
Minnetonka, MN
55305 Website 952-544-6806 Choices Psychotherapy Ltd 7901 Xerxes Ave S
Suite 225
Bloomington, MN
55431 Website 952-544-6806 Choices Psychotherapy Ltd 7975 Stone Creek Dr
Suite ...
Description: Current list of certified Dialectical Behavior Therapy (DBT) IOP Providers.
Date:
January
21, 2026
... to complete the permanent telehealth provider assurance statement 6806 before June 1, 2022. Providers will no longer ... have an approved Telehealth Provider Assurance Statement (DHS-6806) on file with DHS. All providers should continue ...
Date:
July
15, 2022
... Request (DHS-6382) Telemedicine Provider Assurance Statement (DHS-6806) Overnight Assistance Provider Assurance Statement (DHS-6808) Home ... Request (DHS-6382) Telemedicine Provider Assurance Statement (DHS-6806) Overnight Assistance Provider Assurance Statement (DHS-6808) Home ...
Description: This page lists all Provider Eligibility and Compliance (PEC) enrollment forms that accept electronic signatures
Date:
August
12, 2025
... Pediatric (age 17 or under)
8.12
1.6806
N/A
1.15
1.15
1.00
...
Date:
November
27, 2017
... Pediatric (age 17 or under)
8.12
1.6806
1.00
1.15
1.15
1.00
...
Date:
September
22, 2017
... fax the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF) to MHCP Provider Enrollment.
Processing Timelines
MHCP ...
... completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF) .
Eligible Recipients
MHCP members are eligible to ...
... submit the Provider Assurance Statement for Telemedicine (DHS-6806) to MHCP Provider Eligibility and Compliance prior to ...
... completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF) .
MHCP allows payment for the following services:
• ...
... completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF) . This includes individually enrolled private-practice therapists ...