Section Title

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Mental Health Therapist

What Is Your Profession?

What is Your Profession?
Licensed Mental Health Provider

What Is Your State License Number?

What is your State License Number?

What Are Your Specialty Areas?

What are your specialty areas?
Anxiety, Depression, Substance Abuse, Co-dependence, Women and Young Women, Race-based work,

Do You Offer Free Consultation?

Do you offer a free consultation?

Do You Have Experience And/Or Trained To Work With The LGBTQ+ Community?

Do you have experience and/or trained to work with the LGBTQ+ community?

Average Fee Per Session

Average Fee Per Session
Billed to Insurance - Fees range from $155 to $185 (insurance usually pays most of this) ---Self-Pay - $100-$130

Client Age

Client Age


2025 E Beltline Ave SE, Grand Rapids, MI 49444

Phone Number


Email Address


Social Media

Social Info

Preferred Pronouns

Preferred Pronouns

Which Ethnicity Do You Identify As?

Which ethnicity do you identify as?

How Would You Describe Your Gender?

How would you describe your gender?

Do You Have a Religious Affiliation?

Do you have a religious affiliation?

What Languages Do You Speak?

What languages do you speak?

What Type of Insurances Do YouAccept?

What type of insurances do you accept?
Priority Health, Blue Cross Blue Shield, Self-Pay

Do You Offer a Sliding Scale?

Do you offer a sliding scale?

How Are You Providing Mental Health Services?

How are you providing mental health services?
Virtual Services, In-Person Services

Statement to Client

Statement to Client
My duty is to walk alongside my clients, by helping to identify any hinderances that are preventing the individual from being the best version of themselves. Along that journey, clients will build an awareness, with the ultimate goal of healing and mending from those experiences.

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