Forms

If you're a new client, please complete the following forms.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, Click here.

BETH CHARNICHKO, MA, LPC, CAGCS, NCC

Address

TELETHERAPY & TELEHEALTH,
LICENSED MENTAL HEALTH CARE NPI #1487978326,
Serving Pennsylvania and Delaware, PA 19352

Phone

940-368-6533

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