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Clearview - Individual/Organization Profile

Profile Type:

Private Practice

Group Practice

Interventionist

Organization or Facility

Educational Consultant

Individual

Name of Practitioner

Credential

Title

Contact Person

(If different than above)

Phone

Cellphone

Email

Website

Address of Services

Other Locations

Organization

Organization/Facility Name

Contact Person

Name (First Middle Last)

Credential

Title

Phone

Intake Phone

Cellphone

Email

Address of Services

Website

Other Locations

For Both Individuals and Organizations

Population Served

Adults

Adolescents

Children

Elderly

GLBT

Male Only

Female Only

Other

Services provided in the following languages

English

Spanish

Farsi

French

Other

Modalities

Acupuncture

CBT

Couples Therapy

DBT

Educational Testing

EMDR

Equine Assisted Therapy

Experiential

Type

Family Program

Family Therapy

Group Therapy

Type

Guided Imagery

Hypnosis

Imago Therapy

Individual Therapy

Intervention

Life/Recovery Coaching

Medication Management

Meditation

Type

Psycho Education Group

Type

Psychological Testing

Somatic Experiencing

Support Groups

Type

Therapeutic Massage

Vocational Testing/Counseling

Yoga

Addiction Alcohol Drug Abuse/Dependency

Other

Specialty Areas

ADD/ADHD

Anger Management

Anxiety Disorders

Autism/Aspergers

Bipolar Disorders

Body Image

Chronic Illness

Codependency

Cutters/Self Harm

Depressive Disorders

Developmental Disabilities

Domestic Violence

Eating Disorders

Family of Origin

Gambling Addiction

Grief and Loss

Learning Disabilities

Pain Management

Personality Disorders

Trauma

Sexual Abuse

Sexual Addiction/Compulsivity

Violence

Other

For Individuals Only

Fees

Private Pay

Sliding Scale

Insurance Reimbursement

Direct Insurance Billing

Medi-Cal/Medicare

Private Practice Rate

For Organizations or Facilities Only

Program Fees:

Detox Cost per day: $

Inpatient Cost per day: $

Residental Rate: $

Residental Length of Stay

Day Treatment/PHP Cost per day: $

Outpatient Monthly rate: $

Outpatient Length of Stay

Family Program: $

Family Program Length

Sliding Scale

Insurance Reimbursement

Direct Insurance Billing

Medi-Cal/Medicare

Facility Type:

Adolescent Chem Dependency

Adolescent Chem Dependency Outpatient

Adolescent Chem Dependency Partial

Adolescent Psychiatric Inpatient

Adolescent Psychiatric Outpatient

Adolescent Psychiatric Partial

Chemical Dependency Extended Care

Chemical Dependency Extended Outpatient

Chemical Dependency Program Partial

Chemical Dependency Transitional Care

Chemical Dependency Treatment Residential

After School Program

Alternative Treatment

Counseling Center

Detox Unit

Eating Disorder Inpatient

Eating Disorder Outpatient

Eating Disorder Partial

Equine Program

Medical Hospital

Psychiatric Extended Care

Psychiatric Inpatient

Psychiatric Outpatient Treatment

Psychiatric Partial Program

Sex Addiction Inpatient

Sex Addiction Outpatient

Sex Addiction Partial

Sober Living

Therapeutic School

Wilderness Program

Other:

Staff Discipline:

MD (other than psychiatrist)

Ph.D

Psy.D

MFT

LCSW

CADAC

LPC

Psychiatrist

Other:

Program Capacity

Program Description

Please take a moment to fill out this Individual/Organization profile. The information will be used to provide our callers and clients with the best referrals possible.

Thank you for your time.

By submitting this form, I hereby authorize Clearview Treatment Programs to include the above information in their database. I also agree to receive information or contact by Clearview Treatment Programs. Clearview Treatment Programs cannot be held liable for the accuracy of information submitted or provided.

Clearview Treatment Programs
1334 Westwood Blvd., Ste 3A
Los Angeles, CA 90024
Phone: 877-894-4651
Fax: 310-474-6115
Email: info@clearviewtreatment.com

Clearview Women's Center for Emotional Regulation

© Copyright 2010 Clearview Treatment Centers. Clearview Centers is licensed by the state of California as an Adult Residential Facility for mental health care