Practice Information
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Your Name
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Your Supervisor's Name
Your Supervisor's Name
If you are currently in supervision, please provide the name of your supervisor.
Profile Information
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LPC, LMFT, LCSW, Etc. (list all that apply seperated by a "," in legal display format)
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Bio's should be about 2 paragraphs in length and writen in third person.
Please list 5 or more clinical spacial interests. (ie: marriage & family, trauma, EMDR, adolesence, etc.)
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Additional Online Profiles to link
Do you have any other profiles such as Psychology Today that you wish to link to your new profile? Please provide their URL's below:
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Terms *
I certify that the above information is true & accurate according to my licensure and acknowlede that the information provide will be used for the purpose of create a public, professional profile on my organization's website.