EMERGENCY TEMPORARY LICENSES ISSUED

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STATE OF ARIZONABOARD OF PSYCHOLOGIST EXAMINERS1740 WEST ADAMS STREET, SUITE 3403PHOENIX, ARIZONA 85007PH: 602.542.8162 FX: 602.364.8279WEBSITE: www.psychboard.az.govEMERGENCY TEMPORARY LICENSES ISSUEDPURSUANT TO A.R.S. § 32‐3124 AND ARIZONA DEPARTMENT OF HEALTH SERVICES ADMINISTRATIVE ORDER 2020‐01PSYCHOLOGIST TEMPORARY LICENSESLast NameFirst NamePractice NameAddress 1Address 2Other State aLizetteRichelleJarynCoreneJohn C.SuzanneJennifer HamadaKathleenHediehAmandaAliciaAishaMeru HealthThe ClinicRichelle Allen, Ph.D.Inner Wisdom & Wellness Psychological Services, PLLCCorene Alvarado, Ph.D., LLCBillings Behavioral Health ClinicSuzanne Anthony, Ph.D.Jennifer (Dr. Hamada)Apato, PsyD, LLCCleveland ClinicGreen Psychological ServicesCornell HealthAlicia Baird, PhDMindful Care Counseling and Consulting, LLC19 South B Street #32095 Van Ness Ave80 Fifth Ave4733 Amber Valley Pkwy, Ste W1112 16th St, NW #4401020 N. 27th St. #41031‐1001 Kaimalie Street, Unit 201B1440 Kapiolani Blvd, Ste 12009500 Euclid Ave A8010685 Briarlake Woods Dr.110 Ho Plaza701 Carden View Court, Ste 181387 Church St.San Mateo, CA 94401San Francisco, CA 94109New York, NY 10011Fargo, ND 58104Washington, DC 20036Billings, MT 59101Ewa Beach, HI 96706Honolulu, HI 96815Cleveland, OH 44195San Diego, CA 92130Ithaca, NY 14853Encinitas, CA 92024Decatur, GA eter W.TristanShannonSarah E.U of Notre Dame Counseling CenterJohns Hopkins University Counseling CenterUniversity fo California, Los AngelesChildren's Mercy Hospital9 Babcock StSt. Liam Hall3003 N. Charles St, Homewood Apts300 Medical Plaza, Ste 12682401 Gillham RoadBrookline, MA 02446Notre Dame, IN 46556Baltimore, MD 21218Los Angeles, CA 90095Kansas City, MO 64108BeebeBradHopebridge, LLC215 S. Hurstbourne Pkwy, Ste 213Louisville, KY 40222BehrmanBelserSamuelKarin NicoleAlan Behrman & Associates PCCornell Health2876 Johnson Ferry Rd., Ste 150110 Ho PlazaMarietta GA 30062Ithaca, NY 14853BernsteinBishopJennieChristopherCornell HealthMid‐Atlantic Children's Services, Inc110 Ho Plaza100 North Pitt Street, Ste 320Ithaca, NY 14853Alexandria, VA trinaMichelleMargaretta H. Bisno, Ph.D.Susan D. Blom, Ph.D., L.P.Cornell HealthThe Snow Psychology Group2222 Harold Way, Ste. CW506237 Second Avenue S.W.110 Ho Plaza6274 Montrose RoadBerkeley, CA 94704Cambridge, MN 55008Ithaca, NY 14853Rockville, MD 20852BockheimBrandtBroderLinda RenéeCharlesFrancineMosaic Psychological, LLCDr. Chad Brandt, PLLCBeck Institute for Cognitive Behavior Therapy425 2nd Ave SW, Ste 2047050 Brookhollow W #410701 Belmont Ave, Ste 700Albany, OR 97321Houston, TX 77241Bala Cynwyd, PA er hrineAlisia RoseOpted Out per ARS § 32‐3226Rogers Behavioral HealthOpted Out per ARS § 32‐3226RecoviaSan Francisco Stress and Anxiety CenterChild Mind InstituteKathrine Butler Hepler, PhDUniversity of Oregon Counseling CenterOpted Out per ARS § 32‐3226406 Science DriveOpted Out per ARS § 32‐322619636 N. 27th Ave, Ste 1063705 Haven Ave #119101 E. 56th Street191 S. Main Street, Ste 51590 E. 13th AvenueOpted Out per ARS § 32‐3226Madison, WI 53711Opted Out per ARS § 32‐3226Phoenix, AZ 85027menlo Park, CA 94025New York, NY 10022Brewer, ME 04412Eugene, OR 97403AZ Board of Psychologist ExaminersPage 1 of 10Arizona TL NumberDate IssuedCA PSY22748CA PSY30493NY 022233 01ND 528DC psy1001378MT 214HI PSY 874HI PSY 1617OH P.5993CA PSY28899NY 022209CA PSY22576GA PSY004164 AL 2/31/202011/25/2020MA 7425IN 20042203APA PS018387CA PSY29907KS 2483;MO 2016016442KY 1288036 IN 020GA PSY003028NY 022701 ;NJ 35SI00620200NY 023656MD 04422 VA 0810004634DC 6/2020CA PSY17109MN LP1194NY 022009MD 05649 VA /2020OR 2935TX 37048PA‐PS017817NJ 35SI00597500CA PSY23571WI 3512MN LP6380NC 5098CA PSY30837NY 016123‐1ME PS1443OR 0/15/20205/26/20203/17/2021

Last NameFirst NamePractice NameAddress 1Address 2Other State llCannonCannon lMarybethDeborah Cahn‐Weiner, Ph.D.Jeannine Lemare Calaba, Psy.D.Opted Out per ARS § 32‐3226Margaret Camacho, PhDWellness 360Cannon PsychologyMcLean HospitalCleveland Clinic Lou Ruvo Ctr for Brain HlthUniversity of Oregon Counseling CenterMarybeth Carter PhD Psychologist61 Avenida de Orinda, #1004820 Gentry AveOpted Out per ARS § 32‐32261272 West Main Rd.2363 James St 6151340 Prudential Dr, Ste A1650 Linda Vista Dr, Ste 209115 Mill Street888 Bonneville Avenue1590 E. 13th Avenue2150 East Tahquitz Canyon Way, Ste 7Orinda, CA 94563Valley Village, CA 91607Opted Out per ARS § 32‐3226Middletown, RI 02842‐6333Syracuse, NY 13206Dallas, TX 75235San Marcos, CA 92078Belmont, MA 02478Las Vegas, NV 89106Eugene, OR 97403Palm Springs, CA 92262CasilloCastelhanoStaciaAndreaThe Ross CenterEating Recovery Center of Maryland57 W 57th Street6535 N Charles Street, Ste ahTrevorChristine G., Ph.D.Therapy ChangesLinda Centeno PhDWest Virginia U Intercollegiate AthleticsColumbia University Counseling & Psychological ServicesSiskin Hospital for Physical RehabBehavioral Pediatric & Family TherapyCornell HealthJonah Cohen PhDPortland DBT Institute, IncU of Notre Dame Counseling Center2221 Camino del Rio South, Suite 200216 Dayton St, #2PO Box 08772920 BroadwayOne Siskin Plaza4501 South 70th Street, Ste 120110 Ho Plaza875 Massachusetts Ave, Ste 835200 SW Macadam Ave, Ste 580St. Liam HallCooperCottleCreekbaumCreelyCutlerDale, Jr.Joseph FThomasIna J.JamesMichelleGradyPrinceton nDeStefanoDevereuxdi daniDomashDouglasDrobWendyAnneWilliam HobartDanielRichardCarleyTodd FMichaelJann MarieAmandaJosephine AnnSharonMalloryC. AishaShannonLeanne sutaniEdelmanPaulBethHeatherSuzanneChadRachelAZ Board of Psychologist ExaminersArizona TL NumberDate IssuedCA 15152CA PSY13961PA PS016507RI PS01123NY 024080TX 37774CA PSY24315MA 11372NV PY0923OR 2966CA 27005 ;NY 7/20205/28/20207/9/2020New York, NY 10019Baltimore, MD 21204NY 071410 1MD 2020San Diego, CA 92108Ridgewood, NJ 07450Morgantown, WV 26507Ney York, NY 10027Chattanooga, TN 37401Lincoln, NE 68516Ithaca, NY 14853Cambridge MA 02139Portland, OR 97239Notre Dame, IN 46556CA PSY30391NJ 4070 NY 014860WV 1185NY 022901TN P0000003319NE 871NY 015294MA 10844OR 2915IN 20040173A;PA PS006711L; MD 9/3/20205/11/20209/10/20201/26/20214/21/2020McCosh Health CenterPrinceton, NJ 0854412 Beaconsfield RdBrookline, MA 024454181 Flat Rock Dr #311Riverside, CA 92505520 S. Grand Ave, Ste 671Los Angeles, CA 900715100 N. Ravenswood #235Chicago, IL 60640Falls Lane Med Center 4419 Falls Road StBaltimore, MD 21211NJ 35SI00525500MA 961CA PSY30705CA PSY29764IL 071006457MD 1611 VA 0810004736NE 207/23/20204/15/20208/13/20205/7/20208/13/2020U of Notre Dame Counseling CenterSharon Dillinger Counseling and ConsultingDr. Mallory DimlerDixon‐Peters Psychotherapy & ConsultingOpted Out per ARS § 32‐3226Leanne Domash, Ph.D.Opted Out per ARS § 32‐3226Sanford L. Drob, Ph.D.200 W. Mercer St, Ste 1112128 Main Rd2524 E. Webster Place, Ste 2037617 Mineral Point Road, Ste 300566 S. San Vicente Blvd, Ste 2011151 Dove Street, Ste 204Opted Out per ARS § 32‐322614 S Bryn Mawr Ave, Ste 2051008 Abbey102921 Wilshire Blvd, Ste 901St. Liam Hall10202 Pacific Avenue S, Ste 211581 Boylston St Suite 702DPO Box 41533Opted Out per ARS § 32‐322677 E. 12th Street #19DOpted Out per ARS § 32‐322626 Court 17/20205/7/202012/31/202010/15/2020VCU Medical CenterLucile Packard Children's HospitalDartmouth College Counseling CtrSuzanne S. EavesSeoul Counseling CenterUCLA Health Operation Mend8730 Stony Point III, Ste 290Richmond, VA 23235730 Welch Rd.Palo Alto, CA 943047 Rope Ferry RdHanover, NH 03755633 Cherry StreetSanta Rosa, CA 954047th floor, 35, Gangnam‐daero 158‐gil, GaSeoul, Republic of Korea, 06034924 Westwood Blvd, Ste 1040Los Angeles, CA 90095WA PSY00001661RI 413 MA 4373WI 1794WI 2806 57CA PSY15257CA PSY16679NY 022010PA PS004910LMI 6301006373CA PSY24422IN 20042312AWA LH00003540MA 9958CA PSY22768CA PSY28424NY 004388CA PSY29318NY 009322NJ 355100591600VA 0810005977CA PSY25032NH 965CA PSY20166AL 1808CA 28436 NY 0Dr. Ina J. CreekbaumJ Creely Psychological ServicesMichelle Cutler, Ph.D. and AssociatesUrban Psychological ServicesWendy David, Ph.D. PLLCThe Lighthouse ClinicThe Psychology CenterRick Deaton, PsyD. A Professional Psychology CorporationOpted Out per ARS § 32‐3226Bryn Mawr Psychological AssociatesJann M. Devereux, Ph.D.Page 2 of 10Seattle, WA 98119Tiverton, RI 02878Milwaukee, WI 53211Madison, WI 53717Los Angeles, CA 90048Newport Beach, CA 92660Opted Out per ARS § 32‐3226Bryn Mawr, PA 19010Birmingham, MI 48009Los Angeles, CA 90024Notre Dame, IN 46556Tacoma, WA 98444Boston, MA 02116Los Angeles, CA 90041Opted Out per ARS § 32‐3226New York, NY 10003Opted Out per ARS § 32‐3226Brooklyn, NY3/17/2021

Last NameFirst NamePractice NameAddress 1Address 2Other State License(s)Arizona TL NumberDate ineSusanAdam MatthewJill Edelson, Ph.D.Janet Eggert PLLCSummit CenterSusa Enochs, Ph.D.Dr. Adam M. Epstein4 Hartford Street4572 S. Hagadorn Rd Ste 3E700 Ygnacio Valley Rd Ste 3201650 Borel Place, Ste 125847 Quince Orchard BLVD STE ENewton, MA 02461East Lansing, MI 48823Walnut Creek, CA 94596San Mateo, CA 94402Gaithersburg, MD 20878MA 4438MI 6301013712CA PSY21108CA PSY15937MD 05937 VA 20206/18/202011/5/20206/24/2020EpsteinEschiletti rbaraJulian oGregJamie AnneLaura L. Epstein, Psy.D.Stress Management Family Counseling CenterJesse S Esqueda, Psy.D.UCLA Operation MendUniversity of Oregon Counseling CenterSynergy EtherapyThe Center for Anxiety, Sleep, and TraumaDr. Barbara FeinbergJ. Vincent Filoteo Psychologist IncStephen C. Fisher, PhDIndiana Polyclinic, PCUniversity of Oregon Counseling CenterLaura E Forsyth, PhDWellQor Psychological Services, PCDr. Laurie Fox Psychological ServiceOregon State University‐CAPSThe Family InstituteU of Notre Dame Counseling CenterPO Box 363300 Boardwalk Dr. Unit 5A660 Hampshire Rd, Ste 100924 Westwood Blvd, Ste 4001590 E. 13th Avenue3539 Douglas Drive North2801 B St #57714502 N. Dale Mabry Hwy, Ste 2005061 Cape May Ave9 Central St, Ste 302201 Pennsylvania Pkwy, Ste 2001590 E. 13th Avenue1601 Carmen Dr. Ste 211135 Pinelawn Rd Ste 204N8680 Rock Riffle Road500 Snell Hall618 Library PlaceSt. Liam HallNassau, DE 19969Fort Collins, CO 80525Westlake Village, CA 91361Los Angeles, CA 90095Eugene, OR 97403Minneapolis, MN 55422San Diego, CA 92102Tampa, FL 33618San Diego, CA 92107Lowell, MA 01852Carmel, IN 46280Eugene, OR 97403Camarillo, CA 93066Melville, NY 11747Athens, OH 45701Corvallis, OR 97331Evanston, IL 60201Notre Dame, IN 9/2020Midland Park, NJ 07432New York, NY 10019‐2802DE B1 0001023CO PSY.0004455CA PSY27377CA 27560OR 789MN LP1454CA PSY30632FL PY0003811CA PSY21505MA 3368IN 20042181AOR 3169CA PSY17938OH P.7539OH 6703OR 2790IL 071 002893IN 20043290B;IL 071.010002CA‐PSY16885FL PY10735CA PSY29609NY PSY022377NY 021740NY 018505 ; FL PY8934GaynerGelmanGeorgeElizabethIrinaAnjaliThe Renfrew CenterAccess Institute2019 17th St.1515 N. Flagler Dr #800110 Gough Street, Ste 301San Francisco, CA 94103West Palm Beach, FL 33401San Francisco, CA 94102GiangrassoGibsonKevinKatherine F.Bergen CBT LLCKurtz Psychology Consulting44 Goodwin Avenue, Ste 10057 W 57th Street 0GiellaGlennGonzalezGoodmanDavidDanielIsaura De La CaridadGraceWellQor Psychological Services of CaliforniaOperation Mend, UCLADr. Isaura GonzalezInstitute for Girls' Development135 Pinelawn Rd, Ste 204N924 Westwood Blvd, Ste 400105 Byrne Avenue95 N Marengo AveMelville, NY 11747Los Angeles, CA 90095Staten Island NY 10314Pasadena, CA 91101CA 22230CA PSY28215NY 015792 01CA ancyAndreaJessicaSue BVaheidehTrudyNathanRogers Behavioral HealthSheppard PrattAction Behavior CentersSelf Awareness WorkshopVaheideh Gudeman, Ph.D.Trudy Narikiyo Guo, Ph.D., LLCPsychology Services of San Francisco, Inc2400 S 102nd Street6501 N. Charles St600 N. Loop 1604 E.420 S. Dixie Hwy Ste 4a5743 Corsa Ave #1121221 Kapiolani Blvd., Ste. 3485758 Geary Blvd, #626Milwaukee, WI 53227Baltimore, MD 21204San Antonio, TX 78232Coral Gables, FL 33146Westlake Village, CA 91362Honolulu, HI 96814San Francisco, CA 94121WI 1624MD 05810TX 37954FL PY3434CA PSY24258HI PSY 469CA 0/8/202012/3/202011/19/2020HallHandfieldRoderick S.VictoriaRoderick S. Hall, Ph.D.Dr. Vicki Handfield1224 10th Street #208Dusty Rd.Coronado, CA 92118Gallup, NM 87305CA 15283NM 1436 WA TE60188712NJ 01711 PA 20HanfordAngelaAngela D. Hanford, PhD24909 104th Ave SE, Ste 101‐AKent, WA elBrandonJoanWestern Psychological and Counseling ServicesCheryl Harumi, PhD, PLLCUnderstanding MindsKurtz Psychology ConsultingBetter Balance Psychological ServicesWLCFS dba Christian Family SolutionsCenter of Insight, LLC2222 E. Powell Blvd,2600 Eldorado Pkwy #23011144 Tesson Ferry Rd., Ste 10157 W 57th Street #1007Opted Out per ARS § 32‐32264351 West College Avenue, Ste 410405 Waltham St., PMB 233Gresham, OR 97080McKinney, TX 75070St. Louis, MO 63123New York, NY 10019‐2802Opted Out per ARS § 32‐3226Appleton, WI 54914Lexington, MA 02421‐7934CA PSY24753WA PY60477313OR 2789TX 37248MO 2016035941NY ‐ 022956MN LP6502WI 2756 57MA 9511 RI dBernadette B. Heid, PsyD, A Professional Psychology CorpLifeWise, LLCPO Box 307611 Sylvan StreetDel Mar, CA 92014Danvers, MA 01923CA 31453MA 10349VT 048 /2021AZ Board of Psychologist ExaminersPage 3 of 103/17/2021

Last NameFirst NamePractice NameAddress 1Address 2Other State License(s)Arizona TL NumberDate IssuedHelmerTracyTracy L Helmer, Psy.D.Opted Out per ARS § 32‐3226Opted Out per ARS § 32‐3226VA 0810003535 OH P7408NJ NJDCATEMP cheidChristine (Reece)BrandonUniversity of Oregon Counseling CenterBrandon Henscheid, PsyD1590 E. 13th AvenuePO Box 214Eugene, OR 97403Afton, WY 21Waimanalo, HI 69795Berkeley, CA 94705Los Gatos, CA 95032Beverly Hills, CA 90212Spokane, WA 99201OR 3001CA 32288 HI 1878ID 203303HI PSY 1280CA PSY25009CA PSY28375CA PSY28797WA HilleIsidroL. ElenaOscarRachelAngelaWaimanalo Health CenterL. Elena Hernandez, PsyDRehabOne Medical GroupRachel Higler, Ph.D. Licensed Clinical Psychologist, PCMasterMind Psychology41‐1295 Kalanianaole Highway2811 A College Ave.13980 Blossom Hill Road, Ste B9300 Wilshire Blvd, Ste 306101 W. Cataldo, Ste aCharlottePaulRobyneFamily First Psychotherapy, Inc.Laura Hirsh PsyDMagdalene Holtam PhDVanessa Honn, Ph.D., P.S.Psychology Consultation Services, IncLakefront Counseling Group, Robyne Howard PsyD4400 Keller Ave, Ste 2004208 Leary Way NW2660 Solace Place Suite A2661 N. Pearl St, #3659663 Tierra Grande, #104PO Box 1852530 Crawford AveOakland, CA 94605Seattle, WA 98107Mountain View, CA 94040Tacoma, WA 98407San Diego, CA 92126Pacific Palisades, CA 90272Evanston, IL 60201CA 25229WA PY60416260CA PSY23823WA PY2973CA PSY7406CA PSY29014IL John HudesmanStanard & Associates, Inc165 West End Ave, Ste 25N309 W. Washington St., Ste 1000New York, NY 10023Chicago, IL 020JoanneMicheleJoshLaurenManhattanville College counseling CenterMichele A Hyman, PsyDAcumen AssessmentsWinthrop Counseling Services2900 Purchase St, Spellman G111489 Baltimore Pike, Ste 2184321 W. 6th St., Ste B6152 Delancey Station St, Ste 206Purchase, NY 10577Springfield, PA 19064Lawrence, KS 66049Riverview, FL land Psychotherapy ClinicMontgomery Behavioral Health Institute, LLCNeuropsychology New England3700 N. Williams Ave4447 N. Central Expy1368 Beacon Street, Ste 116Portland, OR 97227Dallas, TX 75205Brookline, MA 02446NY NY003687IL 071 005316MI 6301015107WI 3132 57 AK PSY644SC 1032NY 016775PA PS 009182KS LP2650IL 071010414WA PY60463539FL MH15901OR 2876TX 34857MA acobJacobusJalazoJansenJohnsonMarniStephane, Ph.D.RoyceLornaWilliamJacob Center for Evidence‐Based TreatmentBaystate Adult Behavioral HealthDr. Royce Jalazo, PAThe Center for Neuropsychology and CouncelingCounseling and Psychological Services1200 N. Fe

DeStefano Michael Bryn Mawr Psychological Associates 14 S Bryn Mawr Ave, Ste 205 Bryn Mawr, PA 19010 PA_PS004910L PSY‐TL‐0416 2/2/2021 Devereux Jann Marie Jann M. Devereux, Ph.D. 1008 Abbey Birmingham, MI 48009 MI_ 6301006373 PSY‐TL‐0101 6/18/2020

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