Behavioral & Counseling Services, LLC
Behavioral & Mental Health Services for Children, Adolescents, Adults & their Families

Medicaid Waiver Consumer Referral

ISC name:  
Contact Phone:  
Email:  
ISC Agency  
Residential Provider Agency:  
Lives at Home?   Yes or No
Client City and County:  
    West Tenn or Middle Tenn
Client Age:  
Client Problem Behavior?
Target Behaviors:
 
Diagnoses:  
Services Needed: