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info@azyoungchildcounseling.com

480.269.1562

18001 N. 79th Avenue Suite C-50
Glendale, Az 85308

I am interested in enrolling in services

Parent first name*

Parent Email*

Parent Phone

Child first name

Child Age

Service I am interested in is:

Child Therapy

Parent Support/Coaching

SPACE Parent Group

Courage Club Children's Group

Managing My Mad Children's Group

Other

Please comment if you would like to utilize your health insurance benefits. We currently accept the following commerial health insurance plans: Aetna, BCBS, UHC, UMR, Optum. We do not accept AHCCCS health plans.

Health Insurance Plan

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