Skip to Content
Department of Mental Health & Developmental Disabilities
Virginia Trotter Betts, Commissioner
Office of Licensure
Useful Licensure Forms
TDMHDD Initial Application for License (MH-4385)
Application for License Renewal (MH-4457)
Application Fee Schedule and Invoice (MH-4453)
TDMHDD Notification of Civil Penalty
MH-5330 Interactive Form (for use by Office of Licensure
staff only)
TDMHDD Allegation/Suspicion of Neglect/Abuse/Dereliction
MH5375 Interactive Form
TDMHDD Licensure Application Fact Sheet (MH-4386)
Application Financial Statement (MH-4466)
Change of Status Form (MH-4454)
TDMHDD Notification of Civil Penalty
MH-5330 Printable Blank Form (for use by Office of Licensure staff only)
TDMHDD Title VI Monitoring Guide
printable blank form (for use by Office of Licensure staff only)
Licensure Links
Licensure Home
Licensure Regional Offices
Licensure Rules
Licensure Forms
Facility/Service License Verification
For Residents
For Visitors
For Business
For Mental Health Services
For Alcohol & Drug Abuse Services
For Developmental Disabilities Services
Crisis Information
Upcoming Events
Suicide Prevention
Newsroom
Sitemap
Contact Us
Related Topics
Mental Health Law & Regulations
Department Overview
Department Offices
Department History
Bredesen's Webpage
Health Care for Kids
Agency Services
Licensure
Policy & Legislation
Recovery Services
TN.GOV Services
Renew Driver's License
One Stop Business Registration
More
TN.GOV Services
TN.GOV Directory
Web Policy
Accessibility
Awards
Survey
Department of Mental Health & Developmental Disabilities
3rd Floor, Cordell Hull Building
Nashville, TN 37243-0675
(615) 532-6500
oc.tdmhdd@state.tn.us