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Clinician Information Form

Please have your clinician complete the data form below. We take it from there.

Credentialing For:

Counselors

Social Workers

MFT'S

Psychologists

Drop Us a Line

First Name

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butchlosey@waybridgecounseling.com

513-688-0092

Behavioral Health Credentialing

4030 Mt. Carmel Tobasco Road

Suite 102

Cincinnati, Ohio 45255

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