Insurance Information

*Do you have an interjurisdictional compact that allows you to practice teletherapy across state lines? If so, which one?

I do not have an interjurisdictional compact

PsyPACT

Social work licensure compact

Other

*Which state is your primary state of licensure

*What is your state licensure number

If you are licensed in any other state, list states and license numbersPlease add state (or abbreviation) and license number

What is your NPI (National Provider Identification) number? (If known)

What is your EIN (Employer Identification Number). If you have not set up an independent business, this would be your social security number

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