Therapist information for inclusion in DBT directory

Please respond to the following questions in order to be listed in the Therapist Directory. We will not verify this information, so please make sure it is accurate, especially your contact information. Questions marked with an * are required. Please use the comments box at the bottom of the page if you would like to give feedback on the form or need to provide clarification for your responses.

Personal and Practice Information
Your name as you want it to appear on the list *
Your name as you want it to appear on the list
Credentials
DBT Certification
Phone
Phone
What is your phone number?
Location of Practice *
Please select location(s) for your practice. If not listed, please select "Other" and fill in the location.
Please state the town or city if not listed above
http://
Insurance (In-Network)
For which insurance panels are you in-network?
Do you submit out-of-network bills?
Training
Additional DBT training *
What type of DBT training do you have?
If you have completed a 2, 5 or 10 day training, who conducted and where was your training?
DBT Consultation Team or Training Team
Note: DBT Consultation Teams are peer led, meet several times each month and are committed to practicing comprehensive DBT. DBT Training Teams typically have an Intensively trained leader who may be paid, meet monthly and are committed to learning effective, comprehensive DBT.
Consultation team *
Do you participate on a regular DBT consultation team?
Training Team *
Do you participate on a DBT training team?
Please enter the name and email of your team leader or contact.
DBT Services
Therapy Services *
When therapeutically indicated, what type of DBT services do you provide?
Populations Served
What population do you work with?
Please provide any comments/suggestions/clarifications for any of the items above.