PsychSource

Please enter information about your Organization. If you are already registered, click here.

Organization Name:

Organization Description:

Street Address:

City:

State:

Zip Code:

County:

Do you want
address published?

Yes No

Office Phone:

(This number will be published)

Toll Free 800 Phone:

(This number will be published)

Intake Phone:

(This number will be published)

Fax:

Web Site URL:

**Contact Name:

**Contact Title:

**Contact Phone:

**Contact Email:

**Contact Password:

Is there a government agency that needs to be contacted before using your services?

Yes No

Disclosure:

I have read the following statement:
Providers: By checking the box above, I acknowledge and understand that private practitioners are not included in the Psychsource database and should not enter their information here. Only organizations providing outpatient services on a sliding-fee scale basis or at no cost to consumers will be included int he Psychsource database. Instead, private providers are encouraged to join their respective professional associations with whom we have partnered. Links to these organizations are provided here and are made available to persons accessing Psychsource.

**for administrative purposes
only - will not be published.