Integrated Neuroscience Services Provider Directory Map
This form is for all Integrated Neuroscience Services providers (doctors, counselors, neurofeedback technicians, etc.) who would like to be listed on our public online provider directory. Please fill out the required information to the best of your ability. You may request at any point to have your information added or removed from the directory.

If you have any questions, concerns, or issues uploading a photo, send your concern or photo to:

Email address *
Company Name *
Provider's First and Last Name *
Email *
Address *
Phone number *
Photo/image for directory listing
Brief description of provider and/or team
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