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.

Understanding the Landscape

The rapid expansion of telehealth has fundamentally changed how therapy is delivered — but it hasn’t changed where therapy is legally considered to occur. In almost every U.S. jurisdiction, a therapy session is legally “taking place” wherever the client is physically located at the time of the session. That means if you’re a Vermont-licensed therapist providing telehealth to a client who’s physically in Massachusetts, you are technically practicing in both states — and must be authorized to do so in each.

This reality creates one of the most complex regulatory challenges in modern mental health care: interstate practice.

While most therapists understand their home state’s licensure requirements, far fewer realize that a single telehealth session with an out-of-state client — even one who has simply crossed a border for college or work — can expose them to regulatory risk. Each state defines “practice,” “telehealth,” and “authorization” differently, and some boards enforce these distinctions actively.

Cross-state telehealth practice intersects with two other compliance areas worth knowing well: mandated reporting obligations across state lines, which can differ from your home state’s requirements, and what to do when a client moves to another state mid-treatment — one of the most common situations that triggers cross-state practice questions.

The Patchwork of State Rules

Broadly, states fall into three categories:

1. Full Licensure Required – The majority of states (e.g., California, New York, Illinois) require that you hold a full in-state license before you can provide therapy to anyone located within their borders.
2. Telehealth-Specific Registration or Limited Licensure – A small but growing number of states (e.g., Florida, Vermont, Colorado starting 2026) have created special “telehealth registration” pathways that allow out-of-state clinicians to offer virtual services without obtaining a full license. These registrations typically include limits on client numbers, duration, or practice scope.
3. Interstate Compact for Therapists – Many professions are adopting interstate compacts — such as PSYPACT for psychologists, the Counseling Compact for LPCs and LMHCs, and the Social Work Compact. These compacts allow eligible clinicians to practice across member states more seamlessly.

However, it’s important to note that compacts don’t automatically grant universal practice rights; they require you to apply, maintain good standing, and often practice only within compact states that have implemented the necessary legislation and infrastructure.

Why This Matters for Clinicians

For mental health professionals — especially those working with clients who move, travel frequently, or split residency — knowing these distinctions is essential. A client who begins therapy in your home state but later moves across a border could suddenly shift your legal and ethical obligations. Even well-intentioned cross-state care can trigger violations if the therapist lacks the required authorization.

Risks include:

• Board discipline for unlicensed practice
• Ethical complaints for exceeding scope of authorization
• Loss of insurance coverage or reimbursement
• Voiding of malpractice insurance protections

States with Specialized Telehealth Pathways

A small but growing number of states have created formal telehealth registration pathways — currently Florida, Arizona, Vermont, Colorado, and Delaware. These pathways let out-of-state clinicians provide virtual services without full licensure. For requirements, fees, and which states are commonly mistaken for offering registration, see our deep-dive guide: Telehealth-Only Licenses for Therapists: 5 States in 2026.

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:

1. Identify which state(s) your clients are or will be in. Be precise. Physical location at session time, not residency.
2. 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.
3. 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.
4. If neither compact nor registration applies, evaluate whether full licensure makes sense given your expected client volume in that state.
5. 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.
6. Document your reasoning and your client’s location verification in your clinical records. If a question ever arises, you want a paper trail.
7. 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.

How to Use This Guide

The summaries below provide plain-language explanations of how each U.S. state handles out-of-state teletherapy. Each section contains a direct link to an authoritative source — typically the Center for Connected Health Policy (CCHP), which maintains the most comprehensive and regularly updated national database of telehealth laws.

This resource is designed to help therapists, supervisors, and practice owners navigate compliance and risk while continuing to serve clients ethically and effectively in a borderless, digital world.

If you are unsure whether your license qualifies under a compact, or if your professional board has implemented a new rule, always confirm directly with your state licensing board before beginning interstate telehealth work.

Find Your State

Alabama

Therapists who want to provide telehealth to clients located in Alabama generally need to hold an Alabama license or another approved authorization. Each professional board sets its own standards, so check your specific board’s rules for telepractice and compact eligibility.

Source: CCHP Alabama

Alaska

If your client is physically located in Alaska, you must typically be licensed in Alaska to provide teletherapy. There are no broad reciprocity agreements, but Alaska supports telehealth as long as standards of care are met.

Source: CCHP Alaska

Arizona

Arizona has been proactive about telehealth expansion. While the state is supportive of virtual care, therapists still need an Arizona license or another approved pathway to treat clients located in Arizona.

Source: CCHP Arizona

Arkansas

To provide therapy to clients in Arkansas, you must be licensed or otherwise authorized to practice in that state. Arkansas applies the same ethical and professional standards to telehealth as to in-person sessions.

Source: CCHP Arkansas

California

If your client is in California, you must hold a valid California license to provide therapy. California also allows a limited 30-day temporary practice period per year for out-of-state clinicians to continue seeing existing clients who are temporarily in California.

Sources:

BBS Telehealth FAQ

Board of Psychology Telehealth FAQ

Colorado

Colorado will soon allow out-of-state clinicians to provide telehealth to Colorado clients under a registration model starting in 2026. Until then, a full Colorado license is required to serve Colorado-based clients.

Source: CCHP Colorado

Connecticut

Connecticut temporarily allowed out-of-state mental health providers to register for telehealth practice during the COVID-19 period, but that provision expired in 2025. Clinicians should now obtain a Connecticut license to see clients there.

Source: CCHP Connecticut

Delaware

Therapists providing telehealth to clients in Delaware must hold a Delaware license or other recognized authorization. Standards of care and documentation requirements mirror those for in-person practice.

Source: CCHP Delaware

District of Columbia

If your client is located in D.C., you need a D.C. license or authorization to provide teletherapy. The same professional and ethical obligations apply as they would for face-to-face sessions.

Source: CCHP District of Columbia

Florida

Florida permits out-of-state providers to offer telehealth if they register as out-of-state telehealth providers and meet conditions such as liability coverage and good standing. Florida licensees do not need to register separately.

Sources: FL Health Telehealth | Florida Mental Health Professions Board

Georgia

Therapists must be licensed or otherwise authorized in Georgia to see clients located there. Georgia participates in several professional compacts that may simplify interstate practice.

Source: CCHP Georgia

Hawaii

Hawaii requires mental health providers to hold a Hawaii license to practice telehealth with clients located in the state. Verify with your profession’s board for any compact participation.

Source: CCHP Hawaii

Idaho

Therapists must be licensed in Idaho to see Idaho clients via telehealth. The state allows teletherapy within scope and applies the same confidentiality and recordkeeping standards as in-person sessions.

Source: CCHP Idaho

Illinois

Therapy delivered to clients physically located in Illinois requires an Illinois license. The Illinois Department of Financial and Professional Regulation (IDFPR) enforces these rules across all behavioral health professions.

Source: CCHP Illinois

Indiana

Indiana requires a valid in-state license to provide teletherapy to clients located within its borders. Telehealth sessions must comply with the same professional and documentation standards as in-person care.

Source: CCHP Indiana

Iowa

Clinicians must hold an Iowa license to practice with Iowa-based clients, whether in person or by telehealth. Professional standards and supervision rules remain the same.

Source: CCHP Iowa

Kansas

Therapists working with Kansas clients via telehealth must be licensed in Kansas. All the same ethical and recordkeeping standards apply.

Source: CCHP Kansas

Kentucky

To practice telehealth with clients located in Kentucky, you need a Kentucky license or participation in a recognized compact. Telehealth services are regulated under the same standards as in-person care.

Source: CCHP Kentucky

Louisiana

Therapists serving clients in Louisiana must be licensed or registered with the state. Louisiana requires compliance with all telehealth-specific consent and documentation standards.

Source: CCHP Louisiana

Maine

Maine requires authorization to serve Maine-based clients via telehealth, but the state is generally supportive of remote practice. Check your board for compact participation.

Source: CCHP Maine

Maryland

Therapists must hold a Maryland license to provide telehealth to clients located in Maryland. The same professional and ethical standards apply.

Source: CCHP Maryland

Massachusetts

To treat clients located in Massachusetts, therapists need Massachusetts authorization. Participation in MassHealth or other programs also requires state licensure.

Source: CCHP Massachusetts

Michigan

Therapists must be licensed in Michigan to treat Michigan-based clients via telehealth. The same consent, documentation, and emergency planning standards apply.

Source: CCHP Michigan

Minnesota

A Minnesota license (or compact participation) is required to provide teletherapy to clients in Minnesota. The state recognizes telehealth as equivalent to in-person practice for legal and ethical purposes.

Source: CCHP Minnesota

Mississippi

Mississippi requires therapists to be licensed or otherwise authorized to provide teletherapy to clients in the state. Compact participation may apply for some professions.

Source: CCHP Mississippi

Missouri

If your client is physically in Missouri, you must hold a Missouri license to provide therapy. Missouri’s telehealth standards mirror those for in-person practice.

Source: CCHP Missouri

Montana

Therapists must hold Montana authorization to treat Montana-based clients. Confirm details with your professional licensing board.

Source: CCHP Montana

Nebraska

A Nebraska license is required to provide teletherapy to clients in Nebraska. Standards of care are the same as in-person services.

Source: CCHP Nebraska

Nevada

Therapists must be licensed in Nevada to provide teletherapy to clients located there. Nevada applies identical standards to in-person and telehealth sessions.

Source: CCHP Nevada

New Hampshire

Therapists must be licensed in New Hampshire to see NH-based clients via telehealth. Limited consultation exceptions may exist for certain disciplines.

Source: CCHP New Hampshire

New Jersey

New Jersey requires a state license to serve clients located in NJ. Providers offering telehealth through an organization must also comply with NJ’s telemedicine registry requirements.

Sources: CCHP New Jersey | NJ DOH Registry

New Mexico

Therapists providing services to clients located in New Mexico must hold NM licensure or participate in a compact where applicable.

Source: CCHP New Mexico

New York

Therapists treating clients in New York must be authorized under NY law. NY OMH and Office of Professions publish detailed telehealth guidance for both private and program-based providers.

Sources: OMH Telehealth | NYS Office of the Professions

North Carolina

Therapists must hold North Carolina authorization to see NC-based clients via telehealth. Boards apply the same standards of care and confidentiality as in-person work.

Source: CCHP North Carolina

North Dakota

Therapists providing telehealth to clients located in North Dakota must be licensed in ND. Compact participation may offer a simplified path for some professions.

Source: CCHP North Dakota

Ohio

Ohio law requires therapists to hold an Ohio license when serving clients located in the state, even by telehealth.

Source: CCHP Ohio

Oklahoma

Therapists must be licensed in Oklahoma to treat clients located in Oklahoma through telehealth.

Source: CCHP Oklahoma

Oregon

Oregon requires therapists to hold Oregon licensure or another authorized pathway to treat clients physically located in Oregon.

Source: CCHP Oregon

Pennsylvania

To provide telehealth to clients in Pennsylvania, therapists must be licensed in Pennsylvania. The Department of State provides additional telemedicine FAQs.

Sources: CCHP Pennsylvania | PA Telemedicine FAQs

Rhode Island

Therapists must hold Rhode Island authorization to provide teletherapy to RI-based clients.

Source: CCHP Rhode Island

South Carolina

Therapists serving clients located in South Carolina must be licensed in SC. Telehealth services are held to the same standards as in-person care.

Source: CCHP South Carolina

South Dakota

Therapists must be licensed in South Dakota to provide telehealth to SD-based clients. Compact membership may simplify multistate practice.

Source: CCHP South Dakota

Tennessee

Tennessee requires therapists to hold Tennessee authorization when providing telehealth to TN-based clients.

Source: CCHP Tennessee

Texas

Therapists must hold a Texas license to provide teletherapy to clients located in Texas. If the client is in another state, both states’ rules must be followed.

Source: CCHP Texas

Utah

Clinicians serving clients located in Utah by telehealth must hold a Utah license or be authorized through a compact.

Source: CCHP Utah

Vermont

Vermont offers a telehealth license that allows out-of-state professionals to provide telehealth to a limited number of Vermont clients, under specific conditions.

Source: CCHP Vermont

Virginia

Therapists must be licensed or registered in Virginia to provide telehealth to VA-based clients. Virginia also participates in multiple professional compacts.

Sources: CCHP Virginia | eHealth Virginia

Washington

Therapists may apply for a probationary or reciprocity license to practice in Washington while completing full requirements. Telehealth follows the same standards as in-person sessions.

Source: CCHP Washington

West Virginia

Therapists who wish to serve clients located in West Virginia must hold West Virginia licensure or an approved compact credential.

Source: CCHP West Virginia

Wisconsin

Therapists must be licensed in Wisconsin to treat clients located in Wisconsin by telehealth. The same standards of care and documentation apply.

Source: CCHP Wisconsin

Wyoming

Therapists serving Wyoming clients via telehealth must hold a Wyoming license or authorization. Telehealth standards are equivalent to in-person care.

Source: CCHP Wyoming

National References

• HHS Telehealth – Licensing Across State Lines: https://telehealth.hhs.gov/licensure/licensing-across-state-lines

• CCHP Policy Finder – Cross-State Licensing & Telehealth Tracker: https://www.cchpca.org/all-telehealth-policies/

• PSYPACT: https://psypact.org/

• Counseling Compact: https://counselingcompact.org/map/

• Social Work Licensure Compact: https://swcompact.org/

Key Takeaways

• Always check the client’s location before each session. Jurisdiction is tied to where the client is physically present — not where their home address is or where the clinician practices.
• Maintain awareness of both licensure and compact options. These may differ by profession (LCSW, LMFT, LPC, Psychologist, etc.).
• Document informed consent carefully. Many states require telehealth-specific consent, including acknowledgment of location, technology, and emergency procedures.
• Stay current. State laws evolve quickly, especially post-COVID, as legislatures modernize telehealth statutes.