Level Therapy Provider Application
Fill out our short form to begin the application process.
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Thanks for your interest in joining.
What's your full name?
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Let's talk about licensure.
Are you licensed to practice? -
Which state?press ENTER
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What is your license number?press ENTER
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What is your License Title? (Ex. LMFT, LPPC, etc.)press ENTER
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How long have you been practicing?press ENTER
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With which population do you prefer to practice?press ENTER
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What do you consider your areas of specialization?press ENTER
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What is your email address?We need this to follow up if we are interested. We will NEVER spam you or give your email to anyone else.press ENTER
