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Practice Description
This area can be used to provide a brief description of your practice, which will be published in both directories. You can also use this space to name modalities, issues treated, etc., not listed elsewhere.
Work setting
check all that apply
- Private Practice
- Community Mental Health
- Hospital
- Other
Do you accept insurance?
Leave unchecked for No.
- Yes
Primary work contact info
Address
Street Address Address Line 2 City State ZIP Code
Primary Work Telephone
Alternate Primary Work Telephone
Primary Fax
Primary Work Email
Primary Work Website
Secondary work contact info
Address
Street Address Address Line 2 City State ZIP Code
Secondary Work Telephone
Alternate Secondary Work Telephone
Secondary Fax
Secondary Work Email
Secondary Work Website
Bio Photo
Photo
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Accepted file types: jpg, gif, png.

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