WLCC Therapist Application

Thank you for your interest in joining the Whole Life Counseling & Consulting network of therapists!

Please complete the application below & provide the requested documents.

Once all components of your application have been received, your application will be reviewed & you will be contacted via email within 1 week with information regarding next steps.

CONTACT INFORMATION

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

EDUCATIONAL BACKGROUND & EXPERIENCE

Degree

Institution (University or College) where you received your degree

Licensed State & Number

Internship Experience Location

Internship Start Date

YYYY

Internship End Date

YYYY

Please provide a brief overview of your internship experience, including what you found most valuable through this experience.

Additional Certifications/Trainings

Specialties/Clinical Preferences

PROFESSIONAL EXPERIENCE & GOALS

Current Employer

Start Date

YYYY

Why do you want to join the Whole Life Counseling & Consulting Network?

How many clients do you want to see per week?

How many total hours do you want to work per week?

Are you currently credentialed with any insurance companies?

If yes, please list the companies below.

If yes, are you licensed as an individual or through an organization?

WLCC CREDENTIALS & DETAILS

If you are invited to join Whole Life Counseling & Consulting, we will pay for you to be credentialed with up to 5 insurance companies from a pre-selected list. It takes approximately 90-120 days for the insurance credentialing process to be completed with no guarantee of an exact time frame.

Would you be open to see self-pay clients until your credentials came through (you can continue working at your current employer during this period if that is not a conflict)?

I understand that the position I am applying for is to be a 1099 Contractor.

I understand that this means that WLCC is not responsible to provide any form of insurance or workers comp benefits. I also understand that taxes will not be withheld from my paychecks & that I am responsible for the payment of my own federal & state taxes.

APPLICATION DOCUMENTS & FINAL STEPS

Please email a copy of your resume & a photo of your current license to careers@wholelifecounselingandconsulting.com with the subject line: Application Documents for [YOUR NAME]

Is there anything else you would like to share with us?

WLCC Therapist Application

Thank you for your interest in joining the Whole Life Counseling & Consulting network of therapists!

Hours

Address

Contact

Disclaimers & Emergency Info