Join VTMHCA
or update your information

All information marked with an asterisk (*) is visible on your directory listing. Home address and phone will not be displayed unless it is your workplace and you insert it into Office fields.

All active VTMHCA members will be included in this directory listing as a part of membership. Your contact information and "Characterizing Your Practice" will be accessible to visitors who are looking for a therapist on the VTMHCA.org website. Feel free to email minimal updates to the Executive Director. Complete this form for major updates, renewals, or if you are a new member.

  • Fields left blank will not overwrite existing information
  • Write the word "delete" in a field you wish to make blank, or send a note if explanation needed

Your listing will not appear until your payment is received. You may pay below by PayPal or mail a check.

We suggest you review some of the completed listings prior to filling out the form below.

Personal Information
*Last Name: *First Name:
Middle Initial:  
Home Address:
Town/City: State: Zip
Home Phone: Personal Email:
Professional Information
*Place of Employment:
*Office Address:
*City: *State: *Zip:
*Office Email: Cell or Other Phone:
*Office Phone: Fax:
Work Setting: Private Practice
Hospital
Non Profit
Agency
Alternative Ed.
*Website: http://
Membership Information
Membership Level:
Are you a student? Yes  No
If you are a student, enter your professor's name for verification
Region:

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Are you a member of AMHCA? Yes   No
Unified Dues Program:
Join both VTMHCA & AMHCA and receive a 20% discount on both memberships. For more information and to join both, please go to: www.amhca.org
*List any degrees that you hold:
*List any other pertinent education
*List other associatons in which you hold membership
*Select any Certifications you hold.

(use Ctrl to select multiples)
*Areas of Experience:

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Characterizing Your Practice
*Counselor Type: (select all that apply)
Adults
Adolescents
Children
Elders
 Individual
Couple
Family
Group
*Give us a brief explanation of your philosophy (max 255 characters)
*Type of Therapy
*Years in Practice
*What's the best way to schedule an appointment?
(select all that apply)		 Call
Email
Write
*Payment Types Accepted:
(select all that apply)		 Cash
Credit Card
Check
Other
*Do you accept insurance? Yes  No
*Types of Insurance Accepted:
Directory Information
Choose a UserID: (editing capability may be added in the future)
Choose a Password:
By submitting this form you agree to allow us to contact you by email to inform you of industry news, important information and renewal notices.