Clinical Individual Provider

Clinical Providers

Are you a mental health provider located in Indiana and would like to list your services on the TeleSalud Directory?

Please complete the form below!

First Name

Last Name

Phone Number

Address

City

Zip Code

Counties Served - press "CTRL" and click your mouse on each option to select more than one

Gender

Languages Spoken - press "CTRL" and click your mouse on each option to select more than one

English Spanish Other

Race

Ethnicity

Hispanic or Latino Not Hispanic or Latino Prefer not to answer

Credentials/Qualifications - press "CTRL" and click your mouse on each option to select more than one

Virtual/In-Person Offerings

Virtual Services In-Person Services

Type of Therapy/Services press "CTRL" and click your mouse on each option to select more than one

Cost Per Session

Types of Insurance Accepted - press "CTRL" and click your mouse on each option to select more than one

Other Payment Options

Self-Pay Sliding Scale Other

Website Link

Hours of Operation

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I authorize ASPIN to contract me for service and referral requests.

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Increasing Accessibility to Mental Health Services