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Ann Busch, Ph.D. Licensed Clinical Psychologist (PAY 16643) 711 D Street, Suite 207 San Rafael, CA 94901 (415) 4560952 FAX: (415) 2957382 DIVORCE COACH INFORMED CONSENT This document contains important
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Start by providing your personal information such as your full name, contact details, and current address.
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Indicate your educational background, including any degrees or certifications you have obtained in psychology or related fields.
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Provide details about your licensure, including the issuing state or organization, license number, and expiration date.
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Include any additional certifications or specializations you have in areas such as child psychology, forensic psychology, or neuropsychology.
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Licensed clinical psychologist psy refers to a professional who has completed the necessary education and training to practice psychology and has obtained a license to do so.
Licensed clinical psychologist psy must be filed by individuals who are licensed to practice clinical psychology.
To fill out licensed clinical psychologist psy, individuals must provide information about their practice, qualifications, and any relevant documentation.
The purpose of licensed clinical psychologist psy is to ensure that individuals practicing clinical psychology are qualified and licensed to do so.
Information such as license number, education, training, and any disciplinary actions must be reported on licensed clinical psychologist psy.
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