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Employee & Student Assistance Program, Business Coaching, & Human Resources

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Partner with Northstar as a Counselor

Counselor Name*
First Last
How many years of counseling experience do you have?*
Please explain why you want to partner with Northstar EAP?*
Do you currently have your own practice?*
- Yes
- No
What is the name of your practice?*
Best phone number and email to reach you:*
Do you plan on continuing your private client counseling?*
- Yes
- No
What is your area of focus/specialty?*
Please list your current credentials, effective and expirations date, if applicable:
Are you open to, or already using, Tele Counseling and/or Virtual Counseling?*
- Yes
- No
Do you use, or do plan, to use a HIPAA compliant platform for these services?*
- Yes
- No
Which platform do you use or plan to use?*
What days/times can you make available for Northstar EAP Clients?*
Please provide a copy of the following:*
Resume, Evidence of State licensure, and Evidence of current malpractice insurance (1mil/3mil) - PDF, DOC, and DOCX formats accepted through this online form.
Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 8 MB.
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