Step 1 of 3 33% Name First Last CredentialsPreferred Pronouns She/Her/Hers He/Him/His They/Them/Theirs CompanyTitleDepartment PhoneMobileFaxMailing Address Business Home Other Address Street Address Address Line 2 City 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 Email WebsiteLinkedin Sobriety Month/Day MM slash DD slash YYYY Birthday Month January February March April May June July August September October November December Clients Served Adolescent Adult (18 and over) Children Female Male LGBTQIA+ Licensed Professionals Veterans Preferred Communication Email Face to Face Fax Phone Social Media Text Message Service Delivery Biofeedback Couples Therapy Dietetic Consult EMDR Equine Therapy Family Therapy Group Therapy Individual Therapy Medical Levels of Care Counseling HR/EAP Psychiatrist Physician - Non Psychiatry Interventionist Detox/Stabilization Hospital Hospital Residential Partial Hospitalization (PHP) Intensive Outpatient (IOP) Sober Living Intensives Coaching Sober Escort/Peer Support Fees State funded/Scholarships Private Pay Sliding Scale Private Insurance Insurance: Aetna Insurance: Anthem Insurance: Blue Cross Blue Shield Insurance: Bright Health Insurance: Cigna Insurance: CVS Insurance: First Health Insurance: Health Choice Insurance: Health Care Service Corp - HCSC Insurance: Humana Insurance: Kaiser Foundation Insurance: Medicare Insurance: Medicaid Insurance: Molina Insurance: Northstar Insurance: Oscar Insurance: Tri-Care Insurance: United Health Insurance: ValueOptions Issues Addressed 12-Step Approach ADD/ADHD Addiction - Substance Use Disorder Anger Management Anxiety Disorders Betrayal Trauma/Partner Bipolar Disorder Co-Dependency Chronic/Fatal Disease Depression Dialectical Behavioral Therapy Disordered Eating Dissociative Identity Disorder Dual Diagnosis Faith Based Gambling/Spending Grief/Loss Internet Addiction LGBTQIA+ Affirming Medication Management Meditation/Relaxation Mood Disorders Nutrition Obsessive-Compulsive Disorder Pain Management Personality Disorders Problematic Sexual Behaviors PTSD Religious Trauma Self-Harm Sexual Disorders Sexual Offenders Shame Trauma
