Mendo Lake
Mental Health
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Provider Directory
Provider Registration Form
Please complete the form below to register as a provider in our directory.
Personal Information
Last Name*
First Name*
License or Degree*
Contact Information
Address
Phone*
Email*
Website
Town*
Practice Details
Hours*
Client Types
Children
Adolescents
Adults
Families
Specialties and Approaches*
Insurances Taken
Language(s)
Availability & Fees
New Client Acceptance
Open to new clients
Accepts Medi-Cal
Accepts Medicare
Fee Structure*
Session Format
Phone
Telehealth
Outdoor
In-person
Areas Served*
Coastal Mendocino County
Inland Mendocino County
Northern Mendocino County
Southern Mendocino County
Northern Lake County
Southern Lake County
Other
Please solve this math problem:
Submit Registration
Mendo Lake
Mendo Lake