Make A Payment Payments Enter Your Payment Details Below KMHC’s payment portal is encrypted and secure using Square®STEP 1: Welcome This information will be used to process your secure paymentName* First Name** Last Name** Email* Phone*STEP 2: BILLING ADDRESSAddress* Street Address City State**AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Submit Payment NowEnter Amount Total $0.00 Credit Card Information* Cardholder Name Card Details Consent* YesI hereby agree to Kentucky Mental Health Care, LLC processing a payment on my behalf for the amount listed above.