Lighthouse Therapist Directory Info Collection Form

You have been invited by an agency to be listed as a trusted therapist in their custom Lighthouse Health and Wellness App. Please fill out any information that you would like to be included in their app. All fields are optional. Thank you!
Please put your directory listing/company name.
Accurate information helps us put your information into the correct agency's app
Physical Address
Max. file size: 128 MB.