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Provider Name

Business Name

Business Genre

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Long Business Description

Business Website Address

Business Phone Number

Business Fax

Business Street Address

City

State

ZIP Code

For LPC-Interns, Supervisors Name

Populations Served

Corporate Member Services Provided

Telemental health

yes

no

telemental health only, no in person sessions

office visits (in person)

yes

no

Insurance Accepted

Clinical Interests

Rates for Self Pay Clients

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