Wholeheart Counseling, PLLC

123 Example Road
New York, NY 12345

email@example.com
(555) 555-5555

Professional Disclosure

Kacy Latham, M.A., NCC, LPC Associate(Texas License #96122).

I am currently under the clinical supervision of Dr. Tara Fox, Ph.D., LPC, LPC-S (Texas License #[Supervisor Number]).

To File a Complaint: Texas Behavioral Health Executive Council 1801 Congress Ave., Ste. 7.300 | Austin, Texas 78701 Phone: (512) 305-7700 | Investigations/Complaints: (800) 821-3205 Website: www.bhec.texas.gov

Wholeheart Counseling, PLLC

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