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ID/DD Waiver/IDD(1915i)
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Provider Registration
Register to become an IDD provider in Mississippi. Please fill out the form below to get started.
Personal Details
Full Name
Email Address
Organization
Phone Number
Services and Locations
Services Provided
Day Services Adult
Pre-Vocational Services
Supported Employment
Supported Living
Support Coordination
Home and Community Supports
Respite
Day Services-Adult (DSA)
Prevocational Services
Supervised Residential Habilitation
Behavior Support/Intervention
Occupational Therapy
Physical Therapy
Speech/Language Therapy
Specialized Medical Equipment and Supplies
Locations Served
Adams
Alcorn
Amite
Yazoo
Account Details
Password
Confirm Password
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