VERIFY INSURANCE - Licasa Treatment Center

Home » VERIFY INSURANCE

Name(Required)

First Last

Phone(Required)

Email(Required)

Who is seeking treatment?(Required)

Yourself

A Loved One

Loved One's Information

Name

First Last

Loved One's Date of Birth(Required)

Your Date of Birth(Required)

Additional Information

Insurance Information

Would you like us to verify your insurance benefits? (or a loved one's insurance benefits?)(Required)

Yes

Policy Holders Name

First Last

Policy Holders Date of Birth(Required)

Policy Holders Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Insurance Company's Name

Name

Insurance Company's Phone Number

Member ID

Group Number

Subscriber relationship to client

Where We Provide Services

Licasa Treatment Center provides mental health PHP and IOP services in California and Texas, with treatment locations in Reseda, California and Conroe, Texas. Services are currently available only to patients located in California or Texas.

"Be a part of, not apart from."

Loved One's Information

Insurance Information

Where We Provide Services