Consumer Information & Good Faith Estimate

Information provided on this website is for informational purposes only and is not a substitute for professional mental health care. Establishing contact through this website, email, phone, or contact forms does not create a therapist-client relationship. A therapist-client relationship is established only after appropriate intake procedures have been completed and both parties have agreed to begin services.

Requesting Records

You have the right to request access to your records. Fees for records requests may apply in accordance with applicable law. To request records, please submit a written request to:

Kintsugi Therapy Group, PLLC

Email: maigen@kintsugitherapygroup.com | Phone: 832-780-9621

Filing a Complaint

The Texas Behavioral Health Executive Council (BHEC) regulates licensed mental health professionals in Texas.

Questions or complaints regarding professional conduct, licensure, or standards of practice may be directed to:

Texas Behavioral Health Executive Council (BHEC)

333 Guadalupe Street, Tower 3, Suite 900, Austin, Texas 78701

https://www.bhec.texas.gov | Phone: (800) 821-3205

Additional consumer protection information is available through the Texas Office of the Attorney General: https://www.texasattorneygeneral.gov/consumer-protection

Good Faith Estimate

Under the No Surprises Act, clients who are not using insurance have the right to receive a Good Faith Estimate of the expected cost of services. A Good Faith Estimate will be provided before services begin and upon request.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.

For more information, visit: https://www.cms.gov/nosurprises or call (800) 985-3059.

Self-Pay Fees

Individual Therapy (50 min): $200

Premarital Counseling Program: $1,200

Limited sliding scale availability.

Provider Information

Kintsugi Therapy Group, PLLC

Maigen Agana, MS, LPC | Texas LPC License No. 76472