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Now that you’ve registered your username and account, complete your listing by entering your therapist information below. Note: You’re able to save your listing and finish it when you’re ready to submit.

About You

Full Name: *
Mental Health Role: *
Business or Practice Name:

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Contact Information

Phone: *

Where Are You Located

Area In Louisville: *
    Zip/Post Code: *

    More About You

    Description (Tell Us About You): *
    Accepting New Clients:
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    Offering Virtual Sessions:
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    Your Qualifications

    Credentials: *
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    License Number:
    This is required for your listing be approved.
    License Expiration:
    Adding your license to make it simple to verify you.
    School Attended: *
    Year Graduated: *
    Upload License:
    Drop files here or
    Allowed file types: .*
    Supervisor Name:
    *Only complete if you're prelicensed.
    Supervisor License:
    *Only complete if you're Prelicensed.
    Certificate Date:
    Other Credentials:
    Example: Organization memberships, etc.

    Your Therapy Practices

    Specialty: *
    Your Areas of Interest: *
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    Session Format: *
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    Age Specialty:
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    Billing and Insurance Accepted

    Price Range:
    Cost Per Session:
    Select Price Range | Ex. $50 - 120
    Sliding Scale:
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    Insurance Types Accepted: *
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    Other Info

    How did you hear about us?:
    What are you most interested in from your membership?:
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