Tim O’Brien Signature Template

Respectfully submitted,          

                                                                                              MM/DD/YYYY

_________________________________________________                             ________________

Timothy J. O’Brien Psy.D. CADC                                                                                  Date
Licensed Psychologist/Licensed Clinical Psychologist
Psytegrity, LLC: 235 S. Maitland Ave., Suite 114 – Maitland, Florida 32751 

Examiner Professional Credentials: 
State & License(s) #s:  Illinois #071010066; Indiana #20043234A
PSYPACT Mobility Program #5846 E. Passport & Interjurisdictional Practice Certificate (IPC);
Association for State and Provincial Psychology Boards (ASPPB)
Certified Alcohol and Drug Counselor #30165; Illinois Certification Board

Respectfully submitted,          

                                                                                    MM/DD/YYYY

_________________________________________________                             ________________

Scott Stubenrauch, Psy.D., BC-TMH, BCTP, DPP                                                       Date
Licensed Psychologist/Licensed Clinical Psychologist
Psytegrity, LLC: 235 S. Maitland Ave., Suite 114 – Maitland, Florida 32751 

Examiner Professional Credentials: 
State & License(s) #s: California #30115; District of Columbia #PSY1001277; Florida #PY10838; Illinois #071007574; Indiana #20043114A; Maryland #06108; New York #023000; North Carolina #5418; South Carolina #1533; Texas #38448; Virginia #0810004823
PSYPACT Mobility Program #4499 E. Passport & Interjurisdictional Practice Certificate (IPC);
Association for State and Provincial Psychology Boards (ASPPB)
Board Certified TeleMental Health Provider (BC-TMH) #599; Center for Credentialing & Education (CCE)
Board Certified Telehealth Professional Level II (BCTP); TeleBehavioral Health Institute (TBHI)
Diplomate in Police Psychology (DPP) #62; Society for Police and Criminal Psychology (SPCP)
National Register of Health Service Psychologists (HSP)
IATP – Certified Clinical Trauma Professional (CCTP)
Diversity, Equity, & Inclusion in the Workplace Certificate; University of South Florida (USF)

Respectfully submitted,          

                                                                                    MM/DD/YYYY

________________________________________________                                 ________________

Kaitlyn Schuler, PhD                                                                                                       Date
Psychology Post Doctoral Fellow
Psytegrity, LLC: 235 S. Maitland Ave., Suite 114 – Maitland, Florida 32751 

Supervising Psychologist 

                                                                                     MM/DD/YYYY

_________________________________________________                              ________________

Scott Stubenrauch, Psy.D., BC-TMH, BCTP, DPP                                                       Date
Licensed Psychologist/Licensed Clinical Psychologist
Psytegrity, LLC: 235 S. Maitland Ave., Suite 114 – Maitland, Florida 32751 

Examiner Professional Credentials: 
State & License(s) #s: California #30115; District of Columbia #PSY1001277; Florida #PY10838; Illinois #071007574; Indiana #20043114A; Maryland #06108; New York #023000; North Carolina #5418; South Carolina #1533; Texas #38448; Virginia #0810004823
PSYPACT Mobility Program #4499 E. Passport & Interjurisdictional Practice Certificate (IPC);
Association for State and Provincial Psychology Boards (ASPPB)
Board Certified TeleMental Health Provider (BC-TMH) #599; Center for Credentialing & Education (CCE)
Board Certified Telehealth Professional Level II (BCTP); TeleBehavioral Health Institute (TBHI)
Diplomate in Police Psychology (DPP) #62; Society for Police and Criminal Psychology (SPCP)
National Register of Health Service Psychologists (HSP)
IATP – Certified Clinical Trauma Professional (CCTP)
Diversity, Equity, & Inclusion in the Workplace Certificate; University of South Florida (USF)

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