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Clinical Supervision Request Form

Please click HERE to see if your desired supervisor is available.

Name *

First Name

Last Name

Email Address *

I am a:

Practicum Student (aspiring intern)

Prelicensed Clinician

I’m interested in Clinical Supervision for:

LP (Licensed Psychologist )

LPC (Licensed Professional Counselor)

LPCC (Licensed Professional Clinical Counselor)

LICSW (Licensed Independent Clinical Social Worker)

LMFT (Licensed Marriage & Family Counselor)

Requested Clinical Supervisor:

Jessica Van Berkum, LMFT

Julia Lambert, LICSW

Sheena O'Brien, LP

Karen MountainJohnson, LPCC

Dr. Stefanie Bauer, LP

Taylor Ryan (Baez), LPCC

Requested location:

Grand Ave (St. Paul)

Highland Park (St. Paul)

Loring Park (Minneapolis)

White Bear Lake

Number of required hours:

Desired Start Date?

YYYY

Additional message (optional)

Thank you!

GRAND AVE, SAINT PAUL
658 Grand Ave, Suite 201 & 202
St. Paul, MN 55105
Office: 612.454.1656
Fax: 1.651.560.3768

HIGHLAND, SAINT PAUL

790 Cleveland Ave S., Suite 217

St. Paul, MN 55116

WHITE BEAR LAKE
4756 Banning Avenue, Suite 210
White Bear Lake, 55110

LORING PARK MINNEAPOLIS
1409 Willow Street, Suite 100
Minneapolis, 55403

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Accessibility Statement

Grander Peace Counseling LLC is a Small and Women Business Enterprise granted by the Central Certification Program sponsored by Hennepin County, Ramsey County, and the City of Saint Paul

GRANDER PEACE COUNSELING LAND ACKNOWLEDGEMENT
With deep respect, we acknowledge that the land we work and gather on was originally inhabited by the Dakota people. We acknowledge the harmful history of slavery, genocide, and forced removal of Indigenous people out of their land. We hope this acknowledgement helps to honor and support the Dakota people and all Indigenous communities. We stand in solidarity with Native nations.

Grander Peace Counseling LLC

658 Grand Avenue, Suite 201,

Saint Paul, MN, 55105,

United States

(612) 454-1656 sheena@granderpeacecounseling.com

Hours

Mon 9am - 9pm

Tue 9am - 9pm

Wed 9am - 5pm

Thu 9am - 5pm

Fri 9am - 5pm