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Affiliate Providers
 | Join Our Network If you are interested in becoming an Acadiana EAP affiliate, you must first go through our application/credentialing process. Because our needs change from time to time, we recommend that you first contact our office to see if providers are needed in your area. You can do so by calling or e-mailing our Office Manager at 888-EAP-7300 or info@acadiana-eap.com.
Our application should be mailed to the following address:
Acadiana EAP, LLC
ATTN: Office Manager
P.O. Box 3544
Lafayette, LA 70502
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Along with the application, you are requested to include: Current resume’ or curriculum vitae Copy of all current licensure, state and/or national certifications Copy of current malpractice/professional insurance, including liability limits and all covered individual names on certificate (minimum requirement: $1,000,000.00 occurrence / 3,000,000.00 aggregate. Completed W-9 Copy(s) of diploma(s)
Affiliate Application (PDF)
W-9 Form (PDF) Clinical Preference Form (PDF) Print this Page Send this Page to a Friend!
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