I am primarily an out-of-network, self-pay provider and do not bill insurance directly. A limited number of plans (Cigna and Aetna, via Alma) are available on an in-network basis — if you'd prefer to use one of those, contact me via Alma for details. If you prefer to not use insurance, I can provide a superbill for reimbursement if your plan includes out-of-network mental health benefits.

Yes. All appointments at Carissimi Mental Health & Wellness PLLC are currently offered via secure video conferencing. This allows for flexible, accessible care from the comfort of your home or office. We do ask that you be in a private, quiet space. 

Yes. Due to medical licensing laws, Nicole can only provide care to individuals located in Nevada at the time of the appointment. You must physically be in NV during each visit, even if you're a resident elsewhere.

Typical follow up frequency is between monthly to quarterly depending on your current needs.

For all appointments, the fee is processed the day of the appointment.

If you need to cancel an appointment for any reason, please give at least 48 business hours notice. Otherwise, your cancellation may include a cancellation fee based on our three-strike policy. 

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Initial visits: Late cancellations or no-shows for initial visits cannot be waived and will be charged the full visit fee.

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Established patient visits:

First late cancel/no-show – Waived as a courtesy

Second – Half of the visit fee

Third and beyond – Full visit fee

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Excusable situations: We understand that serious and unexpected events—such as hospitalization, family emergencies, or dangerous weather—can happen. In these cases, please let us know as soon as possible, and we may waive the fee at our discretion.

This practice is not available for emergency services and does not have an emergency hotline that is answered after hours. Portal, email, and phone communication is not appropriate for urgent matters.

If you should have a medical emergency, please call 911 or go to your nearest emergency room. If you are in a mental health crisis please call 911 or the National Suicide Prevention Lifeline at 988.

Medication refills and changes are usually handled during follow-up appointments so we can make sure your treatment stays safe and effective. If you need a refill between visits, reach out as early as possible through the portal or office contact method. We’ll review your request during business hours and let you know if an appointment is needed.

We take a holistic approach and look at the whole picture, not just symptoms. Depending on your needs, we may discuss herbs, supplements, sleep, nutrition, movement, stress management, and other lifestyle supports alongside medication management. We aim to recommend options that are thoughtful, safe, and tailored to you.

Yes, we’re happy to collaborate with other members of your care team when it’s helpful and with your permission. Coordinated care can make your treatment more seamless and support better outcomes, especially when medications, therapy, and medical care are all part of the plan.

Your first visit is a chance for us to get to know you, your history, and what you’d like support with. We’ll review your symptoms, current medications, past treatment, wellness goals, and any herbs or supplements you’re using. From there, we’ll talk through a personalized plan that fits your needs and feels realistic for you.