2021 YMCA of Greater Seattle Social Impact Center’s Staff Disclosure Statement This disclosure statement covers behavioral health services that includes crisis outreach and outpatient behavioral health services Crisis Outreach Services: Staff provide individual and group therapy with specific focus on a variety of populations, such as: Substance Use Disorders, Individual, Couples and Family Therapy and Peer Counseling Staff use various methods of therapy, which may include a combination of Cognitive Behavioral, Existential, Mindfulness, Motivational Interviewing, Narrative, Person-Centered, and Trauma-Focused therapies Treatment is individualized depending on client needs Outpatient Behavioral Health Services: Staff provide individual and group therapy with specific focus on a variety of populations, such as: Substance Use Disorders, Individual, Couples and Family Therapy and Peer Counseling Staff use various methods of therapy, which may include a combination of Cognitive Behavioral, Existential, Mindfulness, Motivational Interviewing, Narrative, Person-Centered, and Trauma-Focused therapies Treatment is individualized depending on client needs Your billing information, including each treatment session, advance payments and refunds, is outlined in the financial form presented at the time of intake and will be updated anytime there are changes to your income or insurance You have the right to refuse treatment and the right to choose a practitioner and treatment modality which best suit your needs Standard for Everyone: The most accurate version of this disclosure statement is sent to your Client Portal at the time of your initial assessment The most current one is available upon request, to be sent to your client portal Additionally, you may request this document at a Y Social Impact Center location in the behavioral health office lobby If you believe a therapist has engaged in unprofessional conduct, and/or would like to obtain a list of the acts of unprofessional conduct listed under RCW 18.130.180, please contact: Washington State DOH, Health Systems Quality Assurance Complaint Intake PO Box 47857 Olympia, WA 98504-7857 360-236-4700 YMCA of Greater Seattle Social Impact Center’s Staff: Agency Affiliated Counselor - Taxonomy 101Y99995L (MH & CDPT in-training): Milos Berovic CG60956142 Expiration Date 1/26/2021 Central Washington University, Law and Justice, Received 2017 NPI 1972166726 Juliana Borges CG60701727 Expiration Date 9/30/20 University of Washington Public Health/Sociology Received 2015 NPI: 1104394949 Byrna Desper, CG60394671, Expiration date 11/7/2020, Antioch Seattle, Social Work Received 1995 NPI 1619447463 Tiarra Fentress, CG60956140 Expiration 9/30/20 University of Washington Ethics & Human Behavior Received 2016 NPI 1790348548 Aaron Haapala, CG60128440 Expiration 12/29/2020, Western WA University General Studies Received 2005 NPI 1831667682 Josh Kent, CG6091769 Expiration 9/30/20 University of Texas, Sociology, Received 2013 NPI 1922669381 Haley Lozano, CG60986128 Expiration 9/30/20 Western Washington University, BA Sociology, Received 2016 NPI 1225680218 Houston McMahan, CG60848777 Expiration 5/21/2020 Seattle School Counseling, 2020 NPI 1720557697 Mol Mell, CG60131635 Expiration 1/4/2021, Seattle Central Community College, Social and Human Received 2012 NPI 1386113264 Grace Piccard, CG60943668 Expiration 4/18/2021, University of Puget Sound, Social Policy Received 2018 NPI 1104343033 Andrea Portillo, CG60827181 Expiation 6/5/2020 University of San Diego, BA Sociology Received 2015 NPI 1659737609 Ricky Thatsanavongsa, CG60701068 Expiration 9/4/20 University of Washington Early Childhood Received 2015 NPI 1912475476 Karrah Vizcarra, CG60953185 Expiration 9/30/2020, Washington State University, Social Science Received 2017 NPI 124793256 Piper Weston, CG60735616 Expiation 11/23/2020, Metro State University, Psychology, Received 2016 NPI 1750853628 Anissa Wongyee, CG60936925 Expiation 10/2/2020, Arizona State University, BA Science, Received 2017 NPI 188115728 Agency-Affiliated Counselor Taxonomy 101Y99996L - MA/PHD (non-licensed): Chris Cronk, MG61001894 Expiration 3/13/2021, US Sports Academy, MS of Sport Science, Received 2003, NPI 1700430329 Vincent Ingarra, CG60143546 Expiration 10/6/2020, Barry University, Social Work Received 1995 NPI 1649377649 Ivona Radunovic, CG60760478 Expiration 10/16/2020, Shoreline Community College, Criminal Justice, Currently attending NPI 1609344167 John Rice, CG60942379 Expiation 5/6/2020, Seattle Pacific University, Psych and Sci Tech Received 2017 NPI 1043876311 Rae Rome, CG60908164 Expiation 9/30/2020, University of Washington, Social Work, Received 2020 NPI 1144799024 Reid Cordero CG60999743 Expiation 10/3/2020, University of Alaska, Counseling, Received 2017 NPI 19822532 Certified Peer Counselor - Taxonomy 175T00000X - Peer Specialist: Vickie Lynn Barron, CG60165021 Expiration 9/30/20, Bellevue Community College, AA, Received 2009 NPI 1215405162 Hellene Gershowtiz, CG60165741, Expiration 9/1/2020, Cornell University, Radiography, Received 1974 NPI 1609345610 Molly Gras-Usry, CG60797356 Expiration 9/3/2020, Evergreen College, Education, Received 1998 NPI 1700355443 Angela Hudson, CG61001244 Expiration 12/3/2020, Seattle University, MA Teaching Received 1996, NPI 1619523081 Ruby Keefe, CG60927327 Expiration 12/3/2020, University of Kansas, BA Received 1988 NPI 1659840569 Crystal Perry, CG60328092 Expiration 4/9/2021, University of Washington, Business Received 1995 NPI 1609345602 Co-Occurring Treatment Providers: Jaime Bliss, LF60134352, Marriage and Family Therapist Expiration 9/30/2020 and CO60631053 Chemical Dependency Professional Trainee Expiration 1/26/2021 Pacific Lutheran University, Received 2006 NPI 1295048205 Taxonomy 106H00000X-Marriage and Family Therapist Amber Smith, LF60617700 Marriage and Family Therapist License Expiration 5/7/2019 CO60694560 Chemical Dependency Professional Trainee, Expiration Seattle Pacific University Received 2013 NPI 1780045245 Taxonomy 106H00000X Marriage and Family Therapist Marriage and Family Therapist - 106H00000X: Lisa Caughron, MG60824629, Expiration 1/29/2021, Pacific Lutheran University, Marriage and Family Therapy Received 2016 NPI 1306314042 Gary Hemminger, LF00000905 Expiration 5/4/2020, Pacific Lutheran University, Marriage and Family Therapy, Received NPI 1689795684 Ashley Hoss, LF60898159 Expiration 10/20/2020, Marriage and Family Therapy, Received 2016 NPI 1508384348 Angela Howe, LF60504861 Expiration 1/17/2019, Marriage and Family Therapy, Received 2012 NPI 1285914283 Erin Lamon, LF60473714 Expiration 2/18/2021, Notre Dame Da Namur, Art Therapy, Received 2010 NPI 1427353226 Heather Penner, LF60102688 Expiration 9/30/20, Seattle Pacific University, Marriage and Family Therapy Received 2003 NPI 118495583 Marriage and Family Therapist Associate License - Taxonomy 106H00000X Marriage and Family Therapist: Jose Fuente, MG60755984 Expiration 5/23/2021, Antioch, CA Psychology, Received 2016 NPI 1093260838 Karina Kemmerer, MG60982762 Expiration 8/20/2020, Saint Martin's University, Counseling Phy, Received 2018 NPI 1013436369 Lora King, MG60881941 Expiration 9/30/20, Settle Pacific University, Marriage and Family Therapy Received 2018, NPI 1780151829 Jonathan Davis, MG60865693 Expiration 9/30/2020 Received 2018 NPI 1972074342 Marissa Pennoyer, MG60868506 9/30/20, Antioch, Marriage and Family Therapy Received 2018 NPI 1811465909 Christina Munro, MG60886743, Expiration 9/17/2019, Pacific Lutheran University, Marriage and Family Therapy, Received 2018 NPI 1134696313 Nichole Woods, LF60923840 Expiration 7/19/2021, Seattle Pacific University, Marriage and Family Therapy Received 2015 NPI 1326517392 Mental Health Counselor - Taxonomy 101YM0800X: Dianne Boyd, LH60160830 Expiration 6/28/20, Antioch Seattle, Psychology, Received 1991 NPI 1255724852 Tyson Conner, LH60735609 Expiration 3/4/2021 Seattle School, Counseling Received 2015 NPI 1427465798 Angela Cupp, LH60908796 Expiration 4/1/2021 Seattle University Psychology Received 2011 NPI 1760886683 Stephanie Foster, LH60815430 Expiration 6/12/2020 Antioch, Seattle Counseling Received 2015, NPI 1477941581 Donnie Goodman, LH00004139 Expiration 4/16/2021, University of South Dakota, Counseling, Received 1992 NPI 1649623059 Liam Ngan, LH61005007 Expiration 9/30/2020 Antioch, Counseling Received 2013 NPI 1013454297 Mike Njenga LH60271417 Expiration 1/8/2020 University of Montevallo, Master Ed Counseling Received 1999 NPI 1487910568 Sue Rash, LH00006570, Expiration:12/18/2020 Seattle Pacific University, Counseling Received 1996 NPI 1821245234 Mental Health Counselor Associate Level - Taxonomy 101Y99996L MA/PHD (non-licensed): Alison Bird, MC60824133 Expiration: 1/10/2021 Calif institute Integral Studies, Counseling Received 2017 NPI 1710394374 Adam Bishop, LH60960157 Expiration 5/26/2021, Seattle School, Counseling, Receiving 2017 NPI 1912476912 Melinda Burns, MC60943909, expiration 5/10/21, Seattle School, Counseling, Received 2019 NPI 1821659285 Elaine Busko, MC60998541 Expiration 11/19/2020 Seattle Pacific, Marriage and Family Received 2018 NPI 1437620655 Emma Jennings, MC61040682 Expiration 2/25/2021, Seattle University, ED in Mental Health, Received 2019 NPI 1801312061 Christine Lay, MC60967756 Expiration 9/30/20, Seattle School Counseling, Received 2019 NPI 1790316073 Andrea Skerry, MC80947948 Expiration date 5/7/2021 Seattle School, Counseling Received 2019 NPI 147301071 Samone Tessmer CG60143057 Expiration 2/12/2021 Capella University, Industrial & Org Psy Received 2009 NPI 1295204188 Kelsey Turner, MC60996448 Expiration 9/30/20 University Montana, MS Clinical Counseling, Received 2019 NPI 1972065134 Mental Health Counselor Associate Taxonomy 101Y99995L - MH&CDPT in Training: Valkyrie Benson, MC60890370 Expiration 9/30/20 University of Washington, Applied Child & Adolescent Psychology Received 2018 NPI 1841766805 Stephanie Dietz, MC6082338 Expiration 9/30/2020 Washington School of Professional Psychology, Counseling Psychology Received 2012 NPI 1518432350 Kerry Egger, MC60902131 Expiration 10/16/2020 University of Washington Child Psychology, Received 2018 NPI 1164999264 John Micheal Jennings MC60882488 Expiration 9/30/2020 The Seattle School of Theology and Psychology, MA in Counseling Psychology NPI 1902373012 Alida Johnson, MC60975624, Expiration 6/30/2020, Antioch, MA in Counseling Psychology, Received 2019, NPI 1881166247 Grayson Moody, MC60626401 Expiration 1/13/2021 Seattle School Counseling, Received 2015 NPI 142752723 Vanessa Nason, MC60792351 Expiration 9/30/2020 Chaminade U of HA Counseling Received 2015 NPI 1205313426 Roseanne Pearson, MC60781257 Expiration 07/20/19 Seattle School, Counseling, Received 2017 NPI 1760951651 Heather Post, MC60997129 Expiration 9/30/2020 City University of Seattle, Counseling Received 2014 NPI 1407374960 Melissa Rudolf, MC60917696, Expiration 12/6/2020, Seattle University, Masters in Psychology, Received 2018 NPI 1407374960 Social Work - Taxonomy 104100000X: Marcy Feinsten, LW60775793 Expiration 11/16/2020 NM Highlands U, Social Work Received 2008 NPI 1720513799 Amanda Huang, LW60852371 Expiration 10/22/2020 Baylor, Social Work, Received 2014 NPI 1245708171 Vanessa McAferty, LW60980529 Expiration Pending, University of Washington, Social Work, Received 2016 NPI 1568831741 Kathrine Mraz, LW60857803, Expatriation 7/19/2020, Boston College, Social Work, Received 2014 NPI 1508299231 Kris Sanborn, LW60228461, Expatriation 2/16/2021, Simmons College, Social Work, Received 2007 NPI 1578609244 Social Work Associate Licenses - Taxonomy 101Y99995L - MH & CDPT in-Training: Carlo Quedado, LW60913237 Expiration 10/7/2020 University of Washington, Social Work, Received 2013 NPI 178001339 Licensed Social Work Associate - Taxonomy 101Y99996L MA/PHD (non-licensed): Grant Buhr, SC60893202, Expiration 9/25/2020, University of Chicago, Social Work, Received 2015 NPI 1497222608 Kevin Cormier, SC60588857, Expiration 9/30/2020 University of Washington, Social Work, Received 2015 NPI 1063887198 Madeleine Fergeson, SC60991619, Expiration 9/30/2020 University of Washington, Social Work, Received 2019 NPI 114578564 Crystal Ho, SC60830341, Expiration 2/16/2021, University of Michigan, Social Work, Received 2017 NPI 1851882831 Katie Lidgard, SC60970292, Expiration 7/3/202, CA state University, Social Work, Received 2019 NPI 1467921379 Sierra Mision, SC60998126, Expiration 10/31/2020 University of Washington, Social Work Received 2019 NPI 1881241982 Alyson Paris, Sc61019561, Expiration 11/15/2020 Turlane, Social Work, Received 2016 NPI 1891337457 Courtney Phillips-Youman, SC60888938, Expiration 10/8/2020, Boston University, Social Work, Received 2018 NPI 1922660588 Rachel Sacco, SC60811585, Expiration 11/22/2020 University of Denver, Social Work, Received 2014 NPI 138600335 Amelia Shah, SC60780579, Expiration University of Washington Social Work, Received 2017 NPI 1750655577 Davon Spencer, SC60913948, Expiration 11/29/2020 University of Washington, Social Work, Received 2017 NPI 1770050411 Giovanna Torres, SC60904659, Expiration 11/29/2020 University of Washington, Social Work Received 2019, NPI 1043789969 Asia Wait, SC60970813, Expiration 11/6/2020, Loyola University, Social Work, Received 2019 NPI 1336793959 Jena Willis, SC60973676, Expiration 3/7/2021, University of Montana, Social Work Received 2019 NPI 1194383281 Social Work Advanced Associate - Taxonomy 101Y99995L MH & CDPT In-training: Kirsten Byrnes, SA60763958, Expiration 8/4/2020, Simmons College, Social Work, Received 2015 NPI 1033595368 Stephanie Lairccia, SA60968665, Expiration 7/1/2020, Case Western Reserve University, Social Work, Received 2018 NPI 1679055941 Substance Use Disorder Professional - Taxonomy 101YA0400X SUDP: Monica Robbins CP00003527, Expiration 1/22/21, Edmond Community College, Chemical Dependency Counseling-Addiction Studies, Received 1995 NPI 188116643 Interns: Emily Bunch, BA, Attending Seattle Pacific University, Marriage and Family Therapy, Expected graduation date June 2022 NPI 1659978922 Felicia Byrnes, BA, Attending The Seattle School, Counseling Psychology, Expected graduation date April 2021, NPI 1073110342 Elliott Duea, BA, Attending Seattle Pacific University, Marriage and Family Therapy, Expected graduation date June 2021, NPI 1003456872 Cassandra Harmon, BA, Attending Northwest University, Clinical Mental Health Counseling, Expected graduation date August 2021, NPI 1891331815 Kara Hill, MA, Attending Adams University, Counseling, Expected graduation date May 2021, NPI 1104423912 Jane Lee, BA, Attending Seattle Pacific University, Marriage and Family Therapy, Expected graduation date June 2022, NPI 1548867815 Genevra Levinson, BA, Attending Seattle School of Theology, Counseling Psychology, Expected graduation date April 2021, NPI 1891392163 Lauren Pate, MA, Attending Northwest University, Clinical Mental Health Counseling, Expected graduation date May 2021, NPI Michelle Tran, BA Attending Seattle Pacific University, Marriage and Family Therapy, Expected graduation date January 2021, NPI 1396249157 Myra Wooten, BA, Attending Adams University, Child Mental Health, Expected graduation date December 2020, NPI 1578193066 Aleece Young, BA, Attending Adams University, Clinical Mental Health Expected graduation date May 2022, NPI 1669079471