Resource Book Information Submission

Do you provide mental health resources in the Houston area?

Please fill out the form below that relates to the position you hold to be included in our mental health resource books.

Therapists/Psychologists

Step 1 of 5

20%

Name(Required)

First Last

Email (For internal purposes only, your email will not be published in the resource book.)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Fax

Company Name

Website

Credentials(Required)

In what year were you licensed?(Required)

If you are an Associate or Intern, list your supervisor name and license here.

Licenses Held(Required)

Licensed Chemical Dependency Counselor

Licensed Clinical Social Worker

Licensed Marriage and Family Therapist

Licensed Professional Counselor

Licensed Psychologist

Licensed Specialist in School Psychology

Licensed Psychological Associate

Ages Served(Required)

Toddlers (age 5 and younger)

Children (ages 6-9)

Pre-teens (ages 10-12)

Teenagers (ages 13-17)

Adults (ages 18-64)

Seniors (ages 65+)

Types of Services Offered(Required)

Couples/Marital Therapy

Family Therapy

Group Therapy

Individual Therapy

Please check the top five specialties or unique services that you have and provide most often to your clients. Check up to 5 options.(Required)

Addiction

ADHD

Adoption

Alcohol Use

Alzheimer's

Anger Management

Anxiety

Asperger's Syndrome

Autism

Behavioral Issues

Bipolar Personality

Blended Families

Career Counseling

Chronic Illness

Chronic Pain

Codependency

Depression

Divorce

Domestic Abuse

Dual Diagnosis

Eating Disorders

Education and Learning Disabilities

Gambling

Grief

Hoarding

Infertility

Infidelity

Intellectual Disability

Internet Addiction

Life Coaching

Marriage Counseling

Medical Detox

Medication Management

Men's Issues

Narcissistic Personality

Obesity

Obsessive-Compulsive Disorder

Oppositional Defiance

Parenting

Pregnancy, Prenatal, Postpartum

Racial Identity

Relationship Issues

Self-Esteem

Self-Harming

Sex Therapy

Sexual Abuse

Sexual Addiction

Sleep Disturbance or Insomnia

Spirituality

Sports Performance

Stress

Substance Abuse

Suicidal Ideation

Testing and Evaluation

Transgender

Trauma and PTSD

Traumatic Brain Injury

Video Game Addiction

Weight Loss

Women's Issues

Service Delivery(Required)

In-person (Face-to-face in-office)

Hybrid - In-person and Telehealth

Virtual Company (i.e. BetterHelp, ZocDoc, etc)

Telehealth Only (Virtual service direct from practice)

Other/Not listed

If you selected "Through a virtual company such as BetterHelp, ZocDoc, etc." in the previous question, please list which company you use here.

How do your clients find you? Check all that apply.(Required)

Personal or Company Website

Virtual company (BetterHelp, ZocDoc, etc)

Psychology Today, Good Therapy, or similar listing service

Professional Association (Houston Marriage and Family Therapy Association (HAMFT), Texas Counseling Association (TCA), etc)

Social Media (Facebook, Instagram, TikTok, etc)

Please expand on your answer to the previous question, including which company, listing service, professional association, or social media outlets your clients find you through.(Required)

How do your clients make contact with you? Check all that apply.(Required)

Personal website contact email

Personal website phone number

Virtual company (BetterHelp, ZocDoc, etc)

Psychology Today contact email

Psychology Today phone number

Association listing

Social media

Please expand on your answer to the previous question (i.e. which virutal company, association listing, or social media platform)(Required)

What percentage of your clients have a co-occurring disorder that includes chemical dependency? Select the best estimated percentage of your client population.(Required)

25%

50%

75%

100%

How do your clients pay for your services?(Required)

Client self-pay (Cash, check, credit, PayPal, Zelle, through website, telehealth platform, or in-person)

Insurance

If you answered "Client self-pay" in the previous question, please include methods here.

Do you accept insurance? If so, please specify which providers you are in-network with:(Required)

Do you use the Disease Concept of addiction in Chemical Dependency Therapy?(Required)

Yes

Do you incorporate 12-step groups in your therapeutic techniques for dealing with addiction?(Required)

Yes

On a scale of 1-10, 1 being the least, how much family involvement do you incorporate in your Chemical Dependency Therapy?(Required)

Do you refer to Chemical Dependency inpatient or outpatient programs? Check all that apply(Required)

Inpatient Chemical Dependency programs like a psychiatric hospital, treatment facility, detox

Outpatient Chemical Dependency program like an intensive outpatient treatment program or partial day hospital program

Name

This field is for validation purposes and should be left unchanged.

Nurse Practitioners, Physician Assistants, and Psychiatrists

Step 1 of 5

20%

Name(Required)

First Last

Email (For internal purposes only, your email will not be published in the resource book.)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Fax

Company/Organization Name

Website

Credentials(Required)

In what year were you licensed?(Required)

Education(Required)

Master’s in Business Administration – MBA

Master of Physician Assistant Studies - MPAS

Master of Public Health - MPH

Master of Science in Nursing - MSN

Doctor of Health Science - DHSc

Doctor of Medicine

Doctor of Nursing Practice - DNP

Licenses and/or Certifications Held(Required)

Advanced Practice Nurse-APN

Advanced Practice Registered Nurse-APRN

Certificate of Additional Qualifications-Psychiatry-CAQ-Psychiatry

Family Nurse Practitioner-FNP

Family Nurse Practitioner-Board Certified-FNP-BC

Family Nurse Practitioner-Certified-FNP-C

Licensed Vocational Nurse-LVN

Nurse Practitioner-NP

Nurse Practitioner-Board Certified-NP-BC

Perinatal Mental Health Certified-PMH-C

Psychiatric Mental Health Nurse Practitioner-PMHNP

Psychiatric Mental Health Nurse Practitioner-Board Certified – PMHNP-BC

Psychiatric Mental Health Clinical Nurse Specialist-PMHCNS

Registered Nurse-RN

Physician Assistant-PA

Physician Assistant-Certified-PA-C

Doctor of Osteopathic Medicine

Medical Doctor-General Practitioner

Medical Doctor-Internist

Medical Doctor-Ob/Gyn

Medical Doctor-Pediatrician

Medical Doctor-Psychiatrist

Medical Doctor - Other

Fellow of the American Society of Addiction Medicine-FASAM

Ages Served(Required)

Toddlers (age 5 and younger)

Children (ages 6-9)

Pre-teens (ages 10-12)

Teenagers (ages 13-17)

Adults (ages 18-64)

Seniors (ages 65+)

Types of Services Offered(Required)

Addiction Treatment

Electroconvulsive Therapy- ECT

Medication Management

Outpatient Detox

Psychotherapy

Psychiatric Evaluation

Spravato Therapy

Testing and Evaluation

Transcranial Magnetic Stimulation-TMS

Please check the top five specialties or unique services that you have and provide most often to your clients. Check up to 5 options.(Required)

Addiction

ADHD

Adoption

Alcohol Use

Alzheimer's

Anger Management

Anxiety

Asperger's Syndrome

Autism

Behavioral Issues

Bipolar Personality Disorder

Blended Families

Career Counseling

Chronic Illness

Chronic Pain

Codependency

Depression

Divorce

Domestic Abuse

Dual Diagnosis

Eating Disorders

Education and Learning Disabilities

Gambling

Grief

Hoarding

Infertility

Infidelity

Intellectual Disability

Internet Addiction

LGBTQIA+

Life Coaching

Marriage Counseling

Medical Detox

Medication Management

Men's Issues

Narcissistic Personality

Obesity

Obsessive-Compulsive Disorder

Oppositional Defiance Disorder

Parenting

Pregnancy, Prenatal, Postpartum

Psychiatric Evaluation

Racial Identity

Relationship Issues

Self-Esteem

Self-Harm

Sex Therapy

Sexual Abuse

Sexual Addiction

Sleep Disturbance or Insomnia

Spirituality

Sports Performance

Stress

Substance Abuse

Suicidal Ideation

Testing and Evaluation

Transgender

Trauma and PTSD

Traumatic Brain Injury

Video Game Addiction

Weight Loss

Women's Issues

Service Delivery(Required)

In-person (Face-to-face in-office)

Hybrid - In-person and Telepsychiatry

Virtual Company (i.e. Teledoc, MDLive, ZocDoc, etc.)

Telepsychiatry Only (Virtual service direct from practice)

Other/Not listed

If you selected "Through a virtual company such as BetterHelp, ZocDoc, etc." in the previous question, please list which company you use here.

How do your patients find you? Check all that apply.(Required)

Company or Organization Website

Virtual company (Teledoc, MDLive, ZocDoc, etc.)

Psychology Today or similar listing service

Professional Association (Texas Medical Association, Harris County Medical Society, Texas Nurses Association, Texas Academy of Physician Assistants, etc.)

Social Media (Facebook, Instagram, TikTok, YouTube, etc.)

Please expand on your answer to the previous question, including which company, listing service, professional association, or social media outlets your clients find you through.(Required)

How do your clients contact with you? Check all that apply.(Required)

Company/Organization website contact email

Company/Organization website phone number

Virtual company (Teledoc, MDLive, ZocDoc, etc.)

Psychology Today contact email

Psychology Today phone number

Association listing

Social media

Please expand on your answer to the previous question (i.e. which virutal company, association listing, or social media platform)(Required)

How do your clients pay for your services?(Required)

Patient self-pay (Cash, check, credit card, PayPal, Zelle, through website, telehealth platform, or in-person)

Insurance

Medicare

Medicaid

TriCare or Military Insurance

If you answered "Client self-pay" in the previous question, please include methods here.

Do you accept insurance? If so, please specify which providers you are in-network with:(Required)

What percentage of your clients have a co-occurring disorder that includes chemical dependency? Select the best estimated percentage of your client population.(Required)

25%

50%

75%

100%

Do you incorporate a recommendation to attend 12-step meetings when addressing addiction?(Required)

Yes

Do you refer to Chemical Dependency inpatient or outpatient programs? Check all that apply(Required)

Inpatient Chemical Dependency programs like a psychiatric hospital, treatment facility, detox

Outpatient Chemical Dependency program like an intensive outpatient treatment program or partial day hospital program

Comments

This field is for validation purposes and should be left unchanged.