Counselor Network Application

Counselor

Salutation

Full name

First Name

Last Name

Phone

Email

Gender

Male

Female

Salutation SF

Do you work with a Center?

Yes

No

Please select your Center from the dropdown below

Name of Center

Center Address

Center ID

Can not find Center

If you cannot find your Center, please have your Practice/Center Reach out to TBCS.. They will need to complete the Counseling Center Application.

Practice Information

Name of Practice

Office Phone Number

Office Email

Fax

Website

Office Address

City

State

ZIP Code

Do you have a Different Mailing Address?

YesNo

Mailing Address

Mailing City

Mailing State

Mailing ZIP Code

Legal

Have you been Subject to a Professional Misconduct Suit?

YesNo

Please Contact Texas Baptists Counseling Services to proceed with this applications. You may contact them at counselingservices@texasbaptists.org or by phone at (214) 828-5188

Have you been Subject to a License Board Complaint?

YesNo

Please Contact Texas Baptists Counseling Services to proceed with this applications. You may contact them at counselingservices@texasbaptists.org or by phone at (214) 828-5188

Resume

Please upload your current resume here.

Resume

References

Reference 1

First Name

Last Name

Email

Phone

Address

City

State

ZIP Code

Reference 2

First Name

Last Name

Email

Phone

Address

City

State

ZIP Code

Abuse Issues	ADD	Addictions
ADHD	Adjustment Disorders	Adjustment to Disability
Adolescent Issues	Adoption Issues	Affair Recovery
Aging Issues	Alcohol Abuse	Alcohol Addiction
Anger Issues	Anxiety	Asperger Syndrome
Attachment	Autism	Bariatric Assessments
Behavior Disorders	Biblical Counseling	Bipolar Disorder
Blended Families	Boundaries	Brain Injury
Burnout	Career Assessments	Career Counseling
Caretaking	Certified Sex Therapist	Chemical Dependency Addiction
Child Behavioral Management	Childhood Abuse	Childhood Sexual Abuse
Children	Children and Families	Chronic Illness
Chronic Mental Illness	Chronic Pain	CISM
Clergy-Church Relations	Clergy Malpractice	CMDR
Codependency	Cognitive Behavioral Therapy	Cognitive Processing Therapy for Trauma
Communication	Compulsiveness	Conduct Disorders
Conflict Resolution	Co-Parenting-Blended Families	Couples
Couple Therapy	Crisis Debriefing	Crisis Management
Critical Incident Stress Debriefing	Cross-Cultural	Cultural Issues
Deaf People - Sign Language	Dementia	Depression
Desiring Healing from Infidelity	Developmentally Delayed	Dissociative Disorders
Divorce Recovery	Domestic Abuse	Domestic Violence
Drug Abuse	Drug Addiction	Early Adult
Eating Disorders	EMDR	Emotional Abuse
Emotional Regulation	Emotional Trauma	Employment Issues
Faith Based	Family Counseling	Family Violence
Fear	Female Clergy	Fertility and Loss
Forensic Concerns	Forgiveness	Foster Children
Gender Identity	Geriatrics	Grief and Loss
Guilt	Identity Issues	Immigration
Individual Counseling	Infertility	Infidelity
Intimacy Challenges	Learning Disabilities	Life Adjustment
Life Coaching	Life Transitions	Loss
Loss from Suicide	Low Self-Esteem	Marriage Counseling
Mens Issues	Ministry related issues	Missionaries
Mood Disorders	OCD	Panic Attacks
Panic Disorders	Parent Facilitation-Blended Families	Parenting
Pastoral Counseling	Pastor and church staff	Pediatrics
Perfectionism	Personal Adjustment Counseling	Personality Disorders
Personality Issues	Personality Testing	Phobias
Physical Abuse	Play Therapy	Pornography
Pornography Addiction	Postpartum	Premarital Counseling
Psychological Assessment	Psychological Testing	PTSD
PTSD Reversal Technique	Recovering from substance abuse	Relationship Issues
Same Sex Attraction	School Issues	Self-Esteem Issues
Self-Harm	Self-Worth	Sex Therapy
Sexual Abuse	Sexual Addiction	Sexual Behavior Problems
Sexual Issues	Sexuality	Sexual Trauma Abuse
Shame	Solution Focused	Spiritual Issues
Stress management	Substance Abuse	Suicidal Ideation
Teenage Girls	Teens	Transition
Trauma	Trauma Resolution	Traumatic Brain Injury
Veterans	Womens Issues	Young Adults
Young Males	Young Moms	Youth
Youth at Risk

Arabic	ASL (American Sign language)	Bulgarian
Burmese	Cantonese	Czech
Dutch	Farsi	French
German	Greek	Hebrew
Hindi	Italian	Japanese
Korean	Laotian	Mandarin
Polish	Portuguese	Romanian
Russian	Spanish	Swahili
Tagalog	Taiwanese	Turkish
Vietnamese

African-American	Anglo	Asian (specify)
European	Hawaiian	Hispanic
Pacific Island

Aetna	Alliance	BCBS
BCBS (PPO)	CHIP	CHIPS
Cigna	EAP	GPA
Humana	Magellan	Medicaid
Medicaid Only	Medicare	MOlina
None	Northstar	PHCS
Scott & White	Texas Medicare	TML
Tricare	Tri Care	Tri Care South
Tri West	United Healthcare

Texas Baptists	Southern Baptists	Bible Church
Catholic Church	Jehovah Witness	Pentecostal Church
Disciples of Christ	Evangelical Church	Jewish
Church of Christ