Provider Listing Update Form

SAMHIN Providers: Submit this form to request updates to your Provider Directory listing. We will make every effort to review and process updates within one week.

If you would like to apply to be listed in our Provider Directory, please complete the Mental Health Provider Registration form.

By completing this form, you grant SAMHIN permission to update your information on our website.

The fields with an asterisk * are required.

Your First and Last Name*

Your Email (SAMHIN use only to contact you if needed; see below for listing email)*

Provider Listing Changes

For the fields below, only enter any NEW or CHANGED information you would like us to update. You can view your current listing on the Mental Health Provider Directory page.

MAIN LOCATION

Street Address

City

State

Zipcode

Office Phone

Office Email

Website URL

SECOND LOCATION

Street Address

City

State

Zip Code

Office Phone

About You & Your Practice

Gender

MaleFemaleTransgenderNon-BinaryPrefer not to answer

Cultural Heritage (select ALL options to display on your listing, including options that currently display)

Asian IndianBangladeshiBhutaneseIndo-CaribbeanIndo-FijianIndo-GuyaneseMaldivianNepaliPakistaniSri LankanBorn in the U.S.

Languages Spoken in Addition to English (select ALL options to display on your listing, including options that currently display)

AssameseBangla/BengaliBodoDogriDzongkhaGujaratiGuyanese CreoleHindiKannadaKashmiriKonkaniMaithiliMalayalamMarathiNepaliOdia (Oriya)PunjabiSinhalaSindhiTamilTeluguUrduNone

Degree (your degrees and / or certifications)

States licensed to practice (to make changes: select ALL options to display on your listing, including options that currently display)

Specialties (to make changes: select ALL options to display on your listing, including options that currently display)

ADHDAddiction and Substance Use DisordersAnger ManagementAnxiety Disorders including PhobiaAutism Spectrum Disorder (ASD) and Neurodiversity-Affirming CareBorderline Personality Disorder (BPD)BurnoutCaregiver StressCareer Counseling and Workplace StressChildren and AdolescentsChronic Medical IllnessChronic PainCouples TherapyDementia and Other Cognitive DisordersDepressionDevelopmental DisordersDissociative DisordersDivorce and SeparationDomestic Violence and AbuseEating DisordersFamily TherapyForensicGambling AddictionGender DysphoriaGeriatric Mental HealthGrief and LossHoarding DisorderImmigration Acculturation and IdentityInfertility and Reproductive Mental HealthInternet, Gaming, and Technology AddictionLearning DisabilitiesLGBTQIA+ Affirming CareMen’s IssuesMilitary, Veterans, and First RespondersMood DisordersNarcissistic Relationship Dynamics and RecoveryObsessive-Compulsive Disorder (OCD)Perinatal Mental Health Pregnancy PostpartumPersonality DisordersPhobiasPsychotic Disorders including Schizoaffective Disorder and SchizophreniaReproductive PsychiatrySchool Issues and Academic StressSelf-Harm and Non-Suicidal Self-InjurySexual Abuse and Sexual TraumaSexualitySex TherapySleep DisordersTrauma and PTSDTraumatic Brain Injury (TBI)Women’s IssuesOther

Treatment Modalities (select ALL options to display on your listing, including options that currently display)

Acceptance and Commitment Therapy (ACT)Attachment-Based TherapyBiofeedbackBrainspottingCognitive Behavioral Therapy (CBT)Cognitive Processing Therapy (CPT)Cognitive Behavioral Therapy–Insomnia (CBT-I)Dialectical Behavior Therapy (DBT)Electroconvulsive Therapy (ECT)Emotionally Focused Therapy (EFT)Equine-Assisted TherapyExposure and Relapse Prevention and DesensitationEye Movement Desensitization and Reprocessing (EMDR)Family Systems TherapyGottman Method Couples TherapyGroup PsychotherapyIntegrative PsychotherapyInternal Family Systems (IFS)Interpersonal Psychotherapy (IPT)Medical DetoxificationMedication ManagementMedication for Opioid Use Disorder (MOUD) and Other Medication AddictionsMindfulness-Based Cognitive Therapy (MBCT)Mindfulness-Based Stress Reduction (MBSR)Motivational Interviewing (MI)Narrative TherapyNeuropsychological TestingPlay TherapyProlonged Exposure (PE) TherapyPsychiatric Evaluation and ConsultationPsychoanalysis/Psychoanalytic PsychotherapyPsychological TestingPsychotherapyPsychodynamic PsychotherapyPsychosomatic MedicineRational Emotive Behavior Therapy (REBT)Schema TherapySolution-Focused Brief Therapy (SFBT)Somatic Therapy / Somatic ExperiencingStructural Family TherapyTranscranial Magnetic Stimulation (TMS)Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)Trauma Informed Therapy

Insurance Accepted (select ALL options to display on your listing, including options that currently display)

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicaidMedicareOtherSelf-pay (not in network with insurance)None

Sliding Fee Scale (yes or no)

Evening Hours (yes or no)

Saturday Hours (yes or no)

Appointment Options (select ALL options to display on your listing, including options that currently display)

In-personTelehealth (virtual)

Practice Description (short paragraph about your practice or any additional affiliations such as universities)[maximum 1,500 characters]

Social Media & Photo

Twitter URL

Facebook URL

LinkedIn URL

Instagram URL

YouTube URL

Photo (jpg or png, maximum 2MB)

South Asian Mental Health Initiative & Network

Update Provider Directory Listing

Provider Listing Changes

About You & Your Practice

Social Media & Photo

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