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25511 Buddy Rd., Maimed Bldg., 401402 Spring/The Woodlands, TX 77380 Phone: 2817480233Email: familyyouth1@hushmail.com http://familyandyouthinstitute.comCLIENT NAME:___: DOB: ___APT. DATE: ___ TIME:___THERAPIST

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ContactConnect Psychological Service PLLC is a mental health service provider that offers various psychological therapies and assessments to individuals seeking support for their mental health.

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Individuals or entities that utilize the services of ContactConnect Psychological Service PLLC and wish to report or claim any insurance reimbursements or tax deductions may be required to file necessary documentation.

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To fill out the forms related to ContactConnect Psychological Service PLLC, individuals should provide accurate personal information, details of services received, and any required documentation to substantiate their claims.

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The purpose of ContactConnect Psychological Service PLLC is to provide comprehensive psychological services that assist individuals in improving their mental health and well-being.

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Information that must be reported includes personal identification details, descriptions of services rendered, payment information, and any relevant medical documentation.

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