Directory Submission Form

Community members contact us regularly asking for names of professionals to assist them with their mental and behavioral health issues.  To answer that need, we have created a comprehensive list of providers to whom we can refer people when they contact us.  Please take 5 minutes to give us your information and please pass along to your colleagues!

Licensed behavioral health professionals in good standing only will be admitted to this directory.


It is recommended to use a work email as this is a public directory
Image Size: 200x250 Pixels Accepted File: GIF,JPG,PNG
*What type of Provider are you?:
*Which best describes your primary location in Palm Beach County?:
Available characters remaining:
Or you may complete a separate form for each location.
*Are you licensed?:
*Is your organization accredited?:
*Please check the boxes next to the populations you serve (check all that apply).:
*Please check all of your areas of specialization.:
Available characters remaining:
Available characters remaining:
*Please check the box next to all forms of insurance/payment you accept::
*Will you see clients on a sliding scale?:
Available characters remaining:
*Can we refer people to you who may not have health insurance?:
*Will you see clients on a pro bono basis?:
Available characters remaining:
*Have you had training to work with veterans and their families?: