Perinatal Support

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1-888-404-7763


Provider Directory Application (non member)
First Name
Last Name
Address 1
Address 2
City
County
State/Province
Zip
Address Type
Email
Phone
Phone Type
Business Name
Job Title
Are you a provider of color?
Do you provide services in a language other than English?
What are your credentials (LMHC, ARNP, etc)
How long have you been in practice?
How long have you worked with pregnant families and families with perinatal mood and anxiety disorders (PMADs)?
Do you meet the following two criteria?	License is in current standing Licensed to practice in the state of Washington
Have you completed two or more of the following?	At least 12 hours of advanced course work about PMADs including CE courses Clinical supervision by a PMAD expert Participate in a consult group or other professional group to further understanding of PMAD management At least 2 years working with families experiencing PMADs For non mental health professionals- 5 hours of PMAD specific coursework, training, CEs
Please share your contributions/training/community enagagement in the field of perinatal mental health. (i.e do you offer training, supervision, participate in community initiatives, volunteer services, etc).
What trainings about perinatal mood and anxiety disorders have you attended (in person or web-format)? Please provide name of organization, dates of training and name of trainer(s) wherever possible.
What is your experience treating parents with perinatal mood and anxiety disorders?
If you prescribe medications, please indicate your knowledge of: (Please note: If you have received specialized training in medication management of pregnant and breastfeeding parents, please include that training in the question above.)	Current psychiatric medications that are safe to use during pregnancy and lactation Where to access consultation about prescribing medication to pregnant and postpartum women, when needed
Requirements to remain on our provider list (By checking the box you agree to the following):	I agree to call Warm Line parents or volunteers back within 24 hours of them contacting me. I will remain current with best practices for the treatment of PMADs and understand PS-WA may request documentation of additional PMAD training at my annual renewal. I will maintain a referral list of resources, support groups and adjunct treatments related to PMADs for my practice area. I will keep my professional listings up to date to ensure parents can access services easily.
Please check all boxes that apply:	I serve parents in the perinatal period. I am a parent or family member.
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Thank you for filling out the application to be listed in our provider directory. We will be in touch within two weeks with next steps.

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Provider Directory Application (non member)

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Need help? Call our toll free peer support line (se habla español).

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Provider Directory Application (non member)

GET CONNECTED.

CONTRIBUTE.