EMDR Basic Consultation Information

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This is a 5 digit number assigned to you by the EMDR Humanitarian Assistance Program – if you were trained by the EMDR Institute, please enter N/A

License Information *

If you are independently licensed, please enter your license # and type (LCSW, LMFT, LPC, etc); if you are practicing under a supervisor’s license, please enter their name and license info

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