Therapists can practice across state lines, but only when they hold a license or other authorization in the state where the client is physically sitting during the session. That single rule — the “place-of-service” rule — decides everything else. The law treats the session as happening at the client’s location, not the therapist’s, so it’s the client’s state that controls which board has jurisdiction, which rules apply, and whether the therapist needs a license, a compact privilege, or a temporary permit to be there at all.
Why the Client’s State Is What Counts
Every state licenses therapists on its own terms, setting its own education, supervised-hours, exam, and ethics requirements. Licensed Professional Counselors, Marriage and Family Therapists, Licensed Clinical Social Workers, and psychologists each have their own board in most states, and the standards do not line up neatly across them.
For a video session, the near-universal rule is that the therapist has to be authorized to practice in whatever state the client is in at that moment. A therapist licensed only in Colorado who takes a video call from a client in a Florida hotel room is, legally, practicing in Florida without a license. Where the therapist is sitting is secondary.1APA Services. What to Know About Doing Telehealth in a Different State
A therapist with clients in several states therefore needs authorization in every one of those states, whether through a compact privilege, a temporary permit, or a full license. There is no federal therapy license that overrides state lines.
Short-Term Exceptions for Existing Clients
Some states carve out narrow exceptions that let an out-of-state therapist see an existing client on a temporary basis, usually when the client is traveling, on a short work assignment, or in the middle of relocating. These provisions exist to preserve continuity of care, not to let a therapist build a caseload in another state.
The details vary widely. Some states allow practice for a limited number of days per year, with 20 a common cap; others require the therapist to register for a temporary permit before providing any service. The rules can also differ by license type: a state may have a temporary-practice provision for psychologists but not for counselors, or the reverse.1APA Services. What to Know About Doing Telehealth in a Different State
One trap: many of the broad telehealth waivers issued during the COVID-19 public health emergency have expired. Therapists who got comfortable treating out-of-state clients in 2020 and 2021 may not realize the legal basis for doing so is gone. Before providing any service to a client in another state, check the current rules directly with that state’s licensing board. Assuming pandemic-era flexibility still applies is one of the fastest routes to an unlicensed-practice complaint.
Interstate Compacts by Profession
Interstate compacts are the biggest structural change to cross-border therapy in decades. They are formal agreements among member states that let a qualified therapist obtain authorization to practice in other participating states without going through the full licensure process in each one. Three compacts now cover the major therapy professions, and each works a little differently.
PSYPACT for Psychologists
The Psychology Interjurisdictional Compact is the most mature, with roughly 42 participating jurisdictions as of 2026. A psychologist licensed in a PSYPACT state can apply for an E.Passport through the Association of State and Provincial Psychology Boards, then obtain an Authority to Practice Interjurisdictional Telepsychology from the PSYPACT Commission. Together, those credentials let the psychologist provide telepsychology services to clients in any other PSYPACT state.2Psychology Interjurisdictional Compact (PSYPACT). Practicing Telepsychology Under PSYPACT
You must hold a full, unrestricted doctoral-level psychology license in at least one PSYPACT state, have no history of disciplinary action on any psychology license, and declare a “home state” you will physically sit in while providing services. You have to be in that home state whenever you use your PSYPACT authorization.2Psychology Interjurisdictional Compact (PSYPACT). Practicing Telepsychology Under PSYPACT The E.Passport application costs $400 and the authorization adds $40, with no renewal fee at present.3Psychology Interjurisdictional Compact (PSYPACT). PSYPACT Fees Chart
Even under PSYPACT, you are responsible for knowing and following the laws of every state you practice into. The compact authorizes your presence; it does not exempt you from local rules.
The Counseling Compact for LPCs
The Counseling Compact covers Licensed Professional Counselors and has been enacted in nearly 40 states and the District of Columbia. Applications opened on September 30, 2025, starting with Arizona and Minnesota, with other member states following.4Counseling Compact. FAQs
Rather than issuing a portable credential, the Counseling Compact grants a “privilege to practice” in each state you apply to. Your home-state license is the foundation: it must be unencumbered and authorize you to independently diagnose and treat at the highest clinical level in a participating state. Your home state, meaning your state of primary residence, must be a compact member.4Counseling Compact. FAQs
Each state you apply to charges a $30 administrative fee to the compact commission, plus whatever fee the individual member state has set.5Counseling Compact. Chapter 7 Rule on Fees Some states also require you to pass a jurisprudence exam on local laws and ethics before the privilege activates.4Counseling Compact. FAQs
The Social Work Licensure Compact
The Social Work Licensure Compact had been adopted by 28 states as of mid-2025, and the commission is on track to begin offering multi-state licenses in 2026.6Association of Social Work Boards. Social Work Licensure Compact on Track for Implementation Timeline Licensed Clinical Social Workers should check the compact’s official site for updates on when applications actually open; the timeline has been described as aspirational rather than firm.
No Compact for Marriage and Family Therapists
There is no interstate compact for Marriage and Family Therapists, and one is not currently in development. The American Association for Marriage and Family Therapy determined a compact was not the right fit for the profession, in part because states like California and New York were unlikely to join, which would have limited its usefulness. AAMFT is instead pursuing what it calls “strategic portability,” working state by state to reduce barriers to licensure transfer. For MFTs who need to practice across borders now, the options are temporary practice permits, where available, or full licensure in each additional state.
Full Licensure in Another State
When no compact covers your profession or the state you need, and temporary practice exceptions don’t fit, the remaining path is licensure by endorsement. This uses your existing license as a foundation to apply for a full, independent license in another state.
Requirements vary, but the pattern is broadly similar. You typically need an active, unrestricted home-state license in good standing, often for at least two years and sometimes as many as five. You need official transcripts confirming your degree meets the new state’s education standards, and documentation of supervised experience verified by a licensed professional, broken out by type of hour. Many states require a jurisprudence exam covering their specific laws and ethics; these usually cost under $40. Expect a criminal background check, often by fingerprint. Application fees usually land in the $100 to $200 range, though some states charge as little as $30 and others as much as $475, and that figure typically does not include the background check or the initial license issuance.
The process is not fast. Between gathering transcripts, waiting on license verification from your home-state board, and general processing, plan on several weeks to a few months. If you know you are moving or plan to build a caseload in a new state, start well before you need to see clients there.
What Happens if You Practice Without Authorization
The consequences of providing therapy in a state where you lack authorization are real and compounding. Therapists tend to underestimate this risk, assuming a good-faith effort or ignorance of the rule will be treated leniently. It usually isn’t.
The licensing board in the state where the unauthorized practice occurred can issue a cease-and-desist order and pursue separate disciplinary action, including fines. Your home state’s board can also act, since most states treat unlicensed practice in another jurisdiction as a violation of professional conduct standards. Home-board sanctions can include reprimands, additional fines, or suspension and revocation of the license you do hold.
The sharpest exposure is often insurance. Professional liability policies typically exclude coverage for illegal acts, and practicing without a license qualifies. If a malpractice claim arises from a session where you were not authorized to be practicing, your insurer can deny the claim outright. That leaves you personally responsible for legal defense and any judgment, a financial exposure that can be catastrophic even where the underlying clinical care was appropriate.
One narrower boundary: for the small subset of therapists whose scope of practice includes prescribing controlled substances, federal law generally requires a separate DEA registration in every state where patients are located. That layer sits on top of state licensure and is not addressed by any of the therapy compacts.7Drug Enforcement Administration Diversion Control Division. Telemedicine State Registration Q&A
Operating Rules Once You Are Authorized
Being legally allowed to see a client in another state is the first hurdle. A few practical requirements apply to every cross-border session regardless of how you got authorization.
HIPAA and the Video Platform
Any platform you use to transmit protected health information has to comply with HIPAA, and the vendor must sign a Business Associate Agreement with you before you use it for client sessions.8Telehealth.HHS.gov. HIPAA Rules for Telehealth Technology The BAA is a binding contract requiring the vendor to implement administrative, physical, and technical safeguards for electronic health information, and to spell out how it handles security incidents, breaches, and client access requests. Under the HHS model agreement, a vendor that discovers a breach of unsecured health information must notify you within 30 calendar days.9HHS.gov. Model Business Associate Agreement
Consumer video apps like FaceTime, Skype, or standard Zoom do not meet the standard unless the vendor offers a HIPAA-compliant version with a signed BAA. Telehealth-specific platforms such as SimplePractice, Doxy.me, and TherapyNotes are built for this and will execute a BAA during onboarding. Confirm any platform provides encryption in transit and at rest, user authentication controls, and audit logging.
Informed Consent and Verifying Client Location
Informed consent should be completed before the first appointment and documented in writing.10Telehealth.HHS.gov. Obtaining Informed Consent For interstate work, standard disclosures aren’t enough. Cover which state’s laws govern the session, what happens if the client travels to a state where you are not authorized to practice, how emergencies will be handled remotely, and the limits of telehealth compared with in-person care.
Ask the client to confirm their physical location at the start of every session. That confirmation is how you verify you are authorized to provide the service that day, and it should be part of your routine, not something you rely on the intake form for. Explain the client’s own privacy responsibilities, too: headphones and a private space matter on their end as much as encryption matters on yours.
Getting Paid
Authorization to practice is not the same as authorization to bill. For Medicare, current law allows beneficiaries to receive telehealth services from anywhere in the United States through December 31, 2027. Behavioral health telehealth services have permanently had geographic restrictions removed, so clients can receive those services from home regardless of whether they live in a rural or urban area.11Centers for Medicare & Medicaid Services. Telehealth FAQ
Private insurance is messier. About half of states require “coverage parity,” meaning insurers must cover a telehealth visit if they would cover the same service in person. Roughly 21 states require “payment parity,” meaning the reimbursement rate must match the in-person rate. In states without payment parity, insurers may reimburse telehealth sessions at a lower rate. And credentialing does not travel with your license: if you are credentialed with an insurer in your home state, that credentialing does not automatically extend to the client’s state, and re-credentialing in each state where you practice can take 60 to 120 days.