First name *
Last name *
What is your specialty?
What is your sub-specialty?
Office or Hospital/Clinic/Pharmacy *
Street Address *
Are you enrolled as a Medicaid provider? *
Do you have a TPI#?
Do you have a NPI#?
Do you consent to having your name appear on the Health and Human Services Commission website recognizing the completion of each training module?
If not enrolled, do you provide services under the direction of an enrolled provider?
May we send you occasional updates and educational opportunities within the Texas Health Steps program? *
How did you hear about us? *
If other, please explain how did you hear about us?
Are you enrolled as a Texas Health Steps Provider?
Enter your CHES #
Retype the password *