Organization or Practice Name
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Primary Contact Name
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Title/Role
Email Address
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Phone
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Website
Address
Main Office Street Address
City
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State
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Country
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Zip Code
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County
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Type of Services Offered (Select all that apply)
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Individual Counseling
Youth Counseline
Psychiatric / Medication Management
Faith-Based / Christian Counseling
Coaching or Peer Support
Family / Couples Therapy
Group Counseling
Substance Use / Recovery Services
Grief / Trauma Support
Case Management
Other
Other (Please specify):
Service Format
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In-person
Telehealth / Virtual
Both
Insurance Accepted (Check all that apply)
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Aetna
Anthem / Blue Cross / Blue Shield
Buckeye Health Plan
CareSource
Cigna / Evernorth
Medical Mutual
Medicaid
Medicare
Molina
Optum / United Healthcare
Paramount
Tricare
Private Pay Only
Insurance is not needed for our services
Other (Please List)
Populations Served (Check all that apply)
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Infants & Toddlers (0–5)
Children (6–12)
Teens (13–17)
Young Adults (18–25)
Adults (26–59)
Older Adults (60+)
Languages Offered (Check all that apply)
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English
Spanish
Arabic
French
Swahili
American Sign Language (ASL)
Other
Other Languages Offered:
Brief Description / Notes for Directory Listing (2–3 sentences describing services, specialties, or approach — this may appear publicly.)
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