First exact Middle exact Last exact City exact State (of License) N/A Alabama Alaska ALBERTA Arizona Arkansas BRITISH COLUMBIA California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine MANITOBA Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada NEW BRUNSWICK New Hampshire New Jersey New Mexico New York NEWFOUNDLAND AND LABRADOR North Carolina North Dakota NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT Ohio Oklahoma ONTARIO Oregon Pennsylvania PRINCE EDWARD ISLAND Puerto Rico QUEBEC Rhode Island SASKATCHEWAN South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming YUKON Zip County exact Area of Expertise ?  Adjustment Disorder (e.g., bereavement, acad, job, mar, or fam prob)Anxiety Disorder (e.g., generalized anxiety, phobia, panic or obsessive-compulsive disorder)Behavioral Health Intervention involving Life Threatening/Terminal DiseaseBehavioral Health Intervention involving Medical Conditions/DisorderBehavioral Health Intervention involving Primary CareBiofeedbackCareer Assessment and CounselingChild Custody EvaluationClinical Neuropsychological AssessmentClinical Neuropsychological InterventionCouples PsychotherapyCrisis Intervention or Disaster InterventionCultural Diversity IssuesDisability Determination or Worker Compensation EvaluationDisorder Diagnosed in Infancy-Adolescence (e.g., ADHD, LD, MR, or Pervasive Devel Disorder)Eating Disorder (e.g., compulsive eating, anorexia, bulimia)Family PsychotherapyForensic Evaluation (e.g., mental competency evaluation)Gay, Lesbian, Bisexual, or Transgender IssuesGender Issues (Men’s/Women’s Issues)Group PsychotherapyHealth Services Consultation to Business or OrganizationsHypnosis or HypnotherapyIndividual PsychotherapyMood Disorder (e.g., depression, manic-depressive disorder)Personality Disorder (e.g., borderline, antisocial)Play TherapyPostTraumatic Stress Disorder or Acute Trauma ReactionProblem Related to Abuse or Neglect (e.g., domestic violence, child abuse)PsychoanalysisPsychoeducational EvaluationPsychological AssessmentPsychopharmacologySchizophrenia or other Psychotic DisorderSchool-based ConsultationSports PsychologyStress Management or Pain ManagementSubstance-Related Disorder (e.g., abuse or dependency involving drug/alcohol) Theoretical Orientation ?  BehavioralCognitive/Cog BehavioralExistential/HumanisticInterpersonalPsychodynamicSocial LearningSystems Ages Served ?  Adolescents (13-17 yrs.)Adults (18-64 yrs.)Children (3-12 yrs.)Infants (0-2 yrs.)Older Adults (65 yrs.) Other Credentials ?  ABPHABPNABPPCPP Language ?  AfrikaansAlbanianArabicArmenianBengaliChinese (Cantonese)Chinese (Mandarin)Chinese (Taiwanese)CzechDanishDutchFarsiFilipinoFinnishFrenchGermanGreekGujaratiHebrewHindiHungarianIndonesianItalianJapaneseKoreanLatinLatvianLithuanianMacedonianMalayalamNepaliNorwegianPolishPortugueseRomanianRussianSerbianSign LanguageSlovakSloveneSpanishSwahiliSwedishTamilTeleguTurkishUkrainianUrduVietnameseYiddish Hospital Privileges ? Yes

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