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Please verify your information that appears on the CPP Provider Contact List or the PCIT Provider Contact List and let us know if your information is correct.

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I have verified my name and information is correct and no changes are needed at this time.

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I would like to be removed from the list

Select all provider list(s) you would like to be added to, removed from, or have your information updated *

CPP

PCIT

Reasons you want to be removed from the list *

No longer providing CPP

Change in role/agency

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Reasons you want to be removed from the list Other...

Do you provide telehealth? *

Yes

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Background information

Have you had any disciplinary actions filed against you within the past 6 months? *

Yes

Please explain the disciplinary actions filed against you within the past 6 months

Additional Training (Select all that apply)

AF-CBT

Cognitive Behavioral Therapy

COS-P

CPP

DBT

DC 0-5

Dyadic Developmental Psychotherapy

EMDR

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MST

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Play Therapy

TCIT

TF-CBT

Other...

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University of Nebraska-Lincoln
Center on Children, Families, and the Law
206 S. 13th St., Suite 1000
Lincoln, NE 68588-0227

402-472-3479

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