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Basic Information

Type of Provider: *

Individual

Organization

Prefix:

optional

Display Name: *

First Name:

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Middle Name:

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Last Name:

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Organization:

Leave blank if you are an independent provider and do business under your own name.

Credentials:

List any degrees or certifications you'd like to appear on your profile

Department:

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Phone:

Crisis Line:

Fax:

Email: *

Website: *

Biography: *

Provider Information

Do you offer telehealth services?:

Yes

Accepting Patients?:

Yes, Accepting Patients

Not Accepting Patients

Locations Served:

Parachute

Rifle

Silt

New Castle

Glenwood Springs

Carbondale

Basalt

Snowmass Village

Aspen

Age Groups Served:

Toddler/Preschool (0-6)

Children (6-13)

Adolescents (14-19)

Adults

Elders (65+)

Types Served:

Individuals

Couples

Families

Groups

Languages:

English

Spanish

Alternative Payment Options:

Mental Health Fund

Sliding Scale Offered

Location

Address Line 1: *

Address Line 2:

City: *

State: *

Zip/Post Code:

County:

Country:

Headshot or Logo

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Logo Upload:

Drop files here or

Allowed file types: jpg,jpeg,gif,png,bmp,ico

Select a logo to share (skip this field if uploading a headshot))

Social Links

Facebook Link:

Instagram Link:

LinkedIn Link:

Twitter Link:

Vimeo Link:

YouTube Link:

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Latitude

Longitude

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Add Your Profile to the HQ Provider Directory

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Your Path To Mental Fitness

Your Path To Mental Fitness

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Your Path To Mental Fitness

Your Path To Mental Fitness