DEA Clinician Network

Join The DEA Clinician Network

We work with culturally competent providers who are committed to serving the specific needs of DEA employees and their families. The Counseling Team is always looking to expand our network of clinicians who work with DEA employees, their spouses and family members.

If you are interested in our joining our TCTI DEA Clinician Network, please complete the TCTI DEA Provider Questionnaire and follow the instructions to email, fax or mail your completed form and supporting documentation. Once your documents are received, our team will contact you with next steps; please note that this may take up to 5-7 business days depending on many applications are under review.

Please be advised that clinicians that are selected to join our network will need to complete a background investigation form. We have provided a quick reference sheet on how to complete the Standard Form-86 and a link to the questionnaire. Please do not complete this form unless requested by TCTI. How to Fill Out the SF-86 Questionnaire for National Security Positions Fillable PDF

Provider Resources

Billing and request forms can be faxed to 760-636-0437, or emailed to: deaeapbilling@thecounselingteam.com

If you have any questions or need additional information, please call us at 800-651-1021.

#1 Admission

#2 Statement of Understanding Blank

#3 Service Receipt

#3b Area Clinician Multi-Use Service Receipt (3-28)

#3c Supplemental Mileage Form

#4 Client Satisfaction Survey

#5 Consent for Release of Confidential Information

#7 Threat of Violence Action Form

#8 Clinician Self Referral Disclosure Form

#9 Traumatic Incident Report Form

#10 Formal Supervisory Referral Authorization to Release Confidential Information

#11 Authorization to Extend Sessions

#13 Consultation Request Form

#14 Consultation Service Receipt

#15 Request for Training

Consent to use Teletherapy or Telephone Sessions

Confidentiality Guidelines (EAP)

EAP Policies and Procedures for DEA Remote Providers

Authorization for Direct Deposit Contractor Form