Therapist information for inclusion in DBT directory

This survey is for currently listed therapists to renew their listing. If you are new to the directory, please do not complete the form below. Please go to this form instead. For those who are renewing, the only fields required on the form below are your name and the information about your DBT team. The other fields and information in the directory will be carried over from your submission last year. If something has changed please complete the appropriate fields so we can update the directory as needed. If you do not complete one of the optional fields, it will be assumed that that information remains current.

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 or 10 day training, who conducted and where was your training?
DBT Consultation Team or Training Team
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 DBT 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.