Board for Licensed Professional Counselors, Licensed Marital and Family Therapists, and Licensed Clinical Pastoral Therapists
Applications
Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
For mailing documents please send them to the Board for Licensed Professional Counselors, Marital and Family Therapists and Clinical Pastoral Therapists, 665 Mainstream Dr, Nashville TN 37243
- Application for License as a Professional Counselor; Mental Health Service Provider Designation; Temporary License as a Professional Counselor with MHSP Designation (PH-2722)
- Application for License as a Marital and Family Therapist (PH-2723)
- Application for License as a Clinical Pastoral Therapist (PH-3596)
- Licensed Professional Counselor Course Work Summary
- Marital and Family Therapist Course Work Summary
- LPC Verification of Supervision Form
- MFT Verification of Supervision Form
- LPC Out-of-State Verification Form
- Tennessee Jurisprudence exam registration form for 2020 for LPC
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of Military Member (PH-4280)
- LPC/MHSP Request for Temporary License Form
- Application to Request LPC Approved Supervisor Status
- Application for Mental Health Service Provider Designation (PH-3533)
- Reinstatement Application (PH-4049)
- Name and Address Change Request (PH-3619)
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Criminal Background Check Instructions