Can Therapists Do Telehealth Across State Lines? (2026)

The short answer, the longer answer, and what to do next.

Last updated: May 2026. This guide is for informational purposes only and does not constitute legal advice. Verify all current requirements with the licensing board in the state where your client is located.

The short answer

Yes, but only if you meet one of three conditions: you’re fully licensed in the state where your client is located, you participate in an active interstate compact that covers both states, or you’ve registered under a telehealth-only pathway in one of the five states that offer one. Therapy is legally considered to occur where the client is physically located, not where you are. If a client logs in from another state, you generally need authorization to practice in that state — even if it’s a one-time session, even if the client is just traveling, even if they were originally your client in your home state.

The longer answer

The fundamental rule across nearly every U.S. state is the same: clinical mental health practice is regulated by the state where the client receives services. For telehealth, that means the client’s physical location at the moment of the session, not the address on their insurance card or where they normally live.

This single rule has significant consequences:

If your client moves from your state to another, you generally cannot continue seeing them without authorization in their new state.
If your client travels and joins a session from a different state, the same rule applies — even for a single session.
If you live and work near a state border, your physical proximity to a client across that border doesn’t matter. Their state’s rules govern.
“Continuity of care” exceptions exist in some states but are narrower than most therapists assume. They typically allow short-term care for an established client temporarily out of state, not ongoing practice.

So you have three legitimate paths to practice telehealth across state lines.

Path 1: Full licensure in the client’s state

Get fully licensed in every state where your clients are located. This is the safest, most flexible option, but it’s also the slowest and most expensive. Each state has its own application, fees, supervision verification, exam requirements (sometimes), and renewal cycle.

For most therapists, full multi-state licensure makes sense only if you have a meaningful client base in each state — or if you intend to build one. For occasional cross-state practice, the time and cost rarely justify the benefit.

Path 2: An active interstate compact

Several professions have established interstate compacts that allow licensed clinicians to practice across member states without full additional licensure:

PSYPACT for psychologists — 43 jurisdictions as of 2026.
The Counseling Compact for licensed professional counselors and licensed mental health counselors — 38 states have enacted as of March 2026, with operational rollout in progress.
The Social Work Licensure Compact for clinical and master’s-level social workers — 25+ states have enacted, with implementation underway.

If your profession has an active compact and both your state and the client’s state are members, this is generally the easiest pathway. The catch: marriage and family therapists do not currently have a national compact, and not every state participates in every existing compact. Verify before you assume coverage.

Path 3: Telehealth-only registration

A small number of states offer a streamlined telehealth-only registration pathway that allows out-of-state clinicians to provide remote services without obtaining full licensure. As of 2026, five states have active pathways that explicitly cover behavioral health professionals:

Florida (Out-of-State Telehealth Provider Registration)
Arizona (Telehealth Registry)
Vermont (Telehealth Registration)
Colorado (Telehealth Provider Registration, effective January 1, 2026)
Delaware (Out-of-State Mental Health Telehealth Registration)

Each pathway has different requirements, fees, and renewal cycles. Common features include: an active license in your home state, no in-person practice in the registration state, professional liability coverage, and a designated in-state agent for service of process.

Several states are commonly mistaken for offering telehealth registration but don’t — including Connecticut (pathway expired June 30, 2025), Maryland (physicians only), and Minnesota (COVID-era only, not permanent). Verify directly with the state licensing board before assuming a pathway exists.

Common scenarios

Here’s how the rules play out in situations therapists actually face:

Your client is moving to another state next month.

You generally cannot continue seeing them after they move unless you obtain authorization in their new state. Some states allow brief continuity-of-care periods (typically 30 days or fewer) to facilitate transition to a new provider. Plan ahead: research the new state’s rules, identify referral options, and discuss the transition with your client well before the move.

Your client is traveling for two weeks and wants to continue sessions.

Most states do not allow you to provide telehealth to a client who is physically in their state without authorization, even for a single session. Some states have explicit short-term exceptions; most do not. The safest approach: pause sessions for the travel period, or check whether the destination state has a specific rule that allows short-term care.

You live near a state border and have clients in the neighboring state.

Your physical proximity doesn’t change the rule. The neighboring state’s licensing or registration rules govern. If you regularly see clients across that border, you should pursue full licensure or compact participation in the neighboring state, not rely on geographic informality.

You’re an LMFT who wants to expand interstate practice.

This is the hardest case. LMFTs do not currently have an active national compact equivalent to PSYPACT, the Counseling Compact, or the Social Work Licensure Compact. Your options are full licensure in additional states or telehealth-only registration in the five states that offer it. The compact landscape may shift in coming years, but for now LMFTs face the most friction in cross-state practice.

Your client is a college student who lives in your state but attends school in another.

The relevant question is: where is the client physically located at the time of the session? If they’re at school in another state, that state’s rules govern. If they’re home for break in your state, your state’s rules govern. The client’s residency on paper doesn’t override their physical location at session time.

What to do next

If you’re considering cross-state telehealth practice, follow this sequence:

Identify which state(s) your clients are or will be in. Be precise — physical location at session time, not residency.
Check whether your profession has an active compact covering both your state and the client’s state. If yes, that’s likely your simplest pathway.
If no compact applies, check whether the client’s state offers telehealth-only registration. Florida, Arizona, Vermont, Colorado, and Delaware are the only five with active pathways for behavioral health as of 2026.
If neither compact nor registration applies, evaluate whether full licensure makes sense given your expected client volume in that state.
If none of the above is workable, refer the client to a clinician who is properly authorized. Continuity of care matters, but practicing without authorization exposes you to disciplinary action and the client to substandard legal protection.
Document your reasoning and your client’s location verification in your clinical records. If a question ever arises, you want a paper trail.
Verify your malpractice insurance covers cross-state practice before relying on any of these pathways. Most policies do, but some restrict coverage by state. Confirm in writing with your carrier.

The bottom line

Cross-state telehealth is legal, increasingly common, and entirely manageable — if you understand which pathway applies to your situation and follow it carefully. The therapists who run into trouble are usually the ones who assume their home-state license is enough, who miss that a client traveled, or who skip verification because “it’s just one session.” The rules are stricter than most therapists expect, but they’re also clearer than most therapists fear once you know the framework.

For a comprehensive state-by-state breakdown of telehealth rules, see our 2026 Compliance Guide for Therapists Practicing Telehealth Across State Lines. For a deep dive on the five states with telehealth-only registration pathways, see our guide on telehealth-only licenses for therapists.

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