Please fill out this online job application form and submit.

First Name *

Last Name *

Address *

State *

Postal code *

City *

Email *

Phone *

Are you currently licensed to provide counseling services in Texas? *

Yes

Are you currently able to provide counseling services independently without supervision? *

Yes

Have you been convicted of or pleaded guilty to a felony within the last five years? *

Yes

If Yes, Please explain

Have you had you received a board complaint or had your licensed suspended? *

If yes, please explain

Do you have a National Provider Identification Number (NPI)? *

What type of license do you have in Texas? *

LPC

LMFT

LCSW

Physchologist

What is the youngest patient you are comfortable providing online therapy?

Describe previous relevant experience in providing counseling services. *

Are you able to devote at least 15 hours per week to working with VCounselors? *

How would you describe your treatment modality in working with clients? *

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