Optum individual therapist credentialing form 2026

1. Click ‘Get Form’ to open the optum individual therapist credentialing form in the editor.
2. Begin by filling out the Clinic Information section. Enter details such as Group Name, Clinic Address, Phone Number, and Credentialing Contact Email. Ensure all fields are accurately completed for a smooth credentialing process.
3. In the Therapist Information section, list each licensed therapist at your clinic. For each therapist, provide their First Name, Last Name, Date of Birth, Social Security Number, Individual NPI, and CAQH ID. If applicable, include any Former Last Names.
4. Make sure to check the box if the clinic phone number or fax number is the same for any therapists listed. This will streamline your submission.
5. Once all information is filled out correctly, review the form for accuracy before saving or exporting it from our platform.

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