We cannot process your intake paperwork until we received all of the required forms and a copy of your insurance card and picture ID.
Please fax all the required forms and a copy of your photo ID and insurance card to (360) 539-1715 in Lacey or to (360) 846-1722 in Longview. Please do not email insurance cards or other confidential information as email is not a secure method of transmission. Once we have all forms and have verified your insurance coverage, we will call you to schedule an initial assessment.
Notice: Due to Washington health care laws, the ROI form should be completed by clients age 13 and up if a parent or other party will need to communicate with us about scheduling or other information.
Providers Addendum to the Informed Consent:
1. Art Tolentino, PhD, LMFT, MAC, CDP, SAP
2. Loretta Crawford, MA, LMHC
3. Kaj Kayij-Wint, LMFT, PhD Candidate
4. Kelly Kimbel, MA, LMHC
5. Mary Trokositz, MA, LMHC, CDP
6. Mary Coacher, MA, LMHC
7. Martha Schumacher, MA, LMHC
8. Douglas Gemmell, MA, LMHC
9. David Moeglein, MSW, LICSW
10. Patricia "Pat" Beck, MA, LMHC
11. Kris Vegvari, MA, LMHC, MAC
12. Lisa Hanna, MA, LMHC