Telehealth-Only Licenses for Therapists: Which States Offer Them in 2026

A complete guide to out-of-state telehealth registration pathways — when they exist, when they don’t, and what therapists actually need to know.

Last updated: April 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.

States with Explicit Telehealth License Options

The Cross-State Practice Problem

If you’re a therapist who wants to see clients in another state, you have three real options:

1. Get fully licensed in that state — months of paperwork, transcripts, supervision verification, exam fees, and renewal cycles for every state on your map.
2. Use an interstate compact — fast and clean if your profession has one and your states participate.
3. Use a telehealth-only registration — a streamlined pathway that lets you practice virtually without full licensure.

Most articles you’ll find on this topic dramatically overstate option three. They cite a 2024 figure that “20 states have telehealth registration processes” without telling you that most of those pathways either expired, apply only to physicians, or carry restrictions that make them impractical for behavioral health clinicians.

This guide does the opposite. It covers exactly which states currently offer a telehealth registration pathway for therapists, which states are commonly mistaken for offering one, and how to decide whether registration is even the right fit for your practice.

For broader context on cross-state telehealth compliance, see our 2026 Compliance Guide for Therapists Practicing Telehealth Across State Lines.

What is a telehealth-only registration?

A telehealth-only registration (sometimes called a telehealth provider permit, registry, or limited license) is a state-issued authorization that allows a clinician licensed in another state to provide remote services to residents of that state — without going through the full licensure process.

The genuine telehealth registration pathways for behavioral health typically share these features:

• Required full license elsewhere. You must hold an active, unrestricted license in your home state.
• No in-person practice. Most prohibit you from opening a physical office or seeing clients face-to-face in the registration state.
• Liability insurance requirements. Coverage must include services provided to clients in the registration state.
• Designation of an in-state agent or contact. Required in several states for service of process.
• Lower cost and faster processing than full licensure.
• Annual reporting or renewal required.

The trade-off: you’re agreeing to a narrower scope of practice in exchange for a faster, cheaper pathway.

States with active telehealth-only registration pathways for therapists

After reviewing current state board rules and statutes as of April 2026, the following states have formal telehealth registration or limited-license pathways that explicitly include licensed mental health professionals.

Florida — Out-of-State Telehealth Provider Registration

Florida has the most established and well-defined pathway. Created under Florida Statute 456.47 in 2019, the registration explicitly covers clinical social workers, mental health counselors, marriage and family therapists, psychologists, and psychotherapists.

Core requirements:

• Active, unencumbered license in another U.S. state, D.C., or U.S. territory
• No disciplinary action in the past five years
• Professional liability coverage of at least $100,000 per claim and $300,000 aggregate
• Designation of a Florida-based registered agent for service of process
• Agreement not to open a Florida office or provide in-person services

Best for: Therapists with snowbird clients, those building a Florida-focused virtual caseload, or clinicians who want a defined, stable pathway.

Arizona — Telehealth Registry

Arizona operates a Telehealth Registry under Arizona Revised Statutes § 36-3606. The registry is administered jointly by Arizona’s various health professional boards. For therapists, the relevant boards are the Arizona Board of Behavioral Health Examiners (LPC, LCSW, LMFT, LISAC) and the Board of Psychologist Examiners (psychologists).

Core requirements:

• Hold a current, valid, unrestricted license in another state that is substantially similar to an Arizona license, for at least one year
• Professional liability insurance covering services provided in Arizona
• Statutory agent for service of process in Arizona
• Arizona Department of Public Safety fingerprint clearance card
• National Practitioner Data Bank self-query within 30 days of application
• Signed statement affirming familiarity with Arizona statutes and rules
• Annual update report

Notable exception: Arizona statute exempts providers from registration if they perform fewer than ten telehealth encounters in a calendar year, or if they’re the established primary care or behavioral health provider for a person who is now temporarily in Arizona.

Also notable: A psychologist with an active PSYPACT APIT does not need Arizona telehealth registration to see Arizona clients.

Best for: Therapists with multiple Arizona clients who don’t qualify under the under-10-encounters exception or PSYPACT.

Vermont — Telehealth Registration

Vermont offers a Telehealth Registration pathway for out-of-state mental health professionals. It is generally designed for limited-scope situations: continuity of care for clients who have moved to Vermont, short-term relationships, or low-volume practice with Vermont residents.

Best for: Therapists who occasionally need to see a Vermont client without setting up shop there. Limits on volume and duration apply.

Colorado — Telehealth Provider Registration (effective January 1, 2026)

Colorado’s new telehealth registration framework took effect under Colorado Revised Statutes 12-30-124, as amended by SB 129 in the 2025 legislative session. The law explicitly allows out-of-state behavioral health providers — psychologists, marriage and family therapists, clinical social workers, professional counselors, and addiction counselors — to register and provide telehealth services to Colorado residents without obtaining a full Colorado license.

Core requirements:

• Out-of-state credential in a comparable profession
• Registration with the appropriate Colorado regulator
• Compliance with Colorado professional practice standards (you’re held to in-state standard of care)
• Specific disclosure requirements to clients

Colorado’s framework is the most accessible and straightforward of the four for behavioral health.

Delaware — Out-of-State Mental Health Provider Telehealth Registration

Delaware has a real and current registration pathway under 24 Del. Code § 6005. The statute specifically permits mental health providers, behavioral health providers, and social workers licensed in another jurisdiction to provide telehealth services to Delaware residents through a registration with the Division of Professional Regulation.

Core requirements:

• Active license in another jurisdiction
• Completion of a Medical Request Form
• Compliance with any additional registration requirements set by the Division

Best for: Therapists with Delaware-based clients or those serving the mid-Atlantic region.

States commonly mistaken for offering telehealth registration

Several states are frequently listed as having telehealth registration pathways but, on closer review, either don’t offer one for behavioral health, have let theirs expire, or have a pathway that’s effectively unusable.

Connecticut. Connecticut had a registration pathway for out-of-state mental and behavioral health providers — but it expired June 30, 2025. Out-of-state therapists now need full Connecticut licensure or compact participation.

Maryland. Maryland’s registration pathway is for physicians and certain other professions. The Maryland Board of Social Work Examiners has explicitly stated it does not offer provisional or temporary licenses for out-of-state social workers. Full Maryland licensure is required.

Minnesota. Minnesota’s MFT board allowed out-of-state MFTs to register during the COVID-19 emergency, but that was a pandemic-era provision, not a permanent pathway. Current rules require full licensure or compact participation for behavioral health.

New Jersey. New Jersey has a telemedicine registry but its application to standalone behavioral health practice is narrow and primarily covers organizational telehealth provision, not individual cross-state therapy.

Mississippi. Mississippi requires a full license or compact participation for behavioral health practice. Earlier pandemic-era temporary registration is no longer in effect.

Hawaii, Iowa, Puerto Rico. These jurisdictions offer narrow exceptions for provider-to-provider consultation, not therapist-to-client telehealth.

Pennsylvania. Pennsylvania has a contiguous-states provision for some healthcare practice but does not offer a registration pathway specifically for cross-state therapy.

If you see a state listed as “has registration” elsewhere, verify directly with the relevant state licensing board whether that pathway applies to your specific profession and is currently active.

How telehealth registration compares to a compact

If your profession has an active interstate compact and your states participate, the compact will usually be the more efficient option:

• PSYPACT for psychologists — 43 jurisdictions as of 2026, with annual authorization renewal fees
• The Counseling Compact for LPCs and LMHCs — 38 states have enacted legislation as of March 2026, with operational implementation rolling out
• The Social Work Licensure Compact for clinical and master’s-level social workers — 25+ states have enacted, in early implementation

Compacts give you broader, ongoing portability without state-by-state registration. But they require:

• Your home state to be a member
• Your destination state to also be a member
• Your profession to have a compact at all (LMFTs, for example, do not yet have a national compact)

Telehealth registration becomes the better option when:

• Your profession has no compact
• One of your states isn’t in the compact
• You only need to practice in one or two specific non-compact states
• You want a faster, lower-cost path than full licensure
• You need to start working before compact authorization processes are complete

When telehealth registration is the right choice

Telehealth registration is particularly worth pursuing when:

• You have one or two clients who relocate. Continuity of care is the most common driver. Rather than terminating a client because they moved to Florida for the winter, registration lets you continue treatment legally.
• You’re testing a market before full commitment. If you’re considering whether to expand fully into a new state, registration lets you build a small caseload and assess demand before committing to full licensure.
• You serve a transient population. Snowbirds, college students, traveling professionals — clients who routinely cross state lines benefit when their therapist can legally follow them.
• Full licensure isn’t worth the ROI. If you’d only see two or three clients a year in a given state, full licensure is overkill.

Telehealth registration is not the right choice when you plan to build a substantial practice in another state, want to provide in-person services there, or your profession has a compact that already covers both your home and destination state.

Practical steps before you register

If you’ve decided telehealth registration is the right move:

1. Verify the current rules directly with the state licensing board. This is not optional. State telehealth law is changing fast, and a guide like this is no substitute for the state board’s official requirements as they exist on the day you apply.
2. Confirm your profession is included. Eligibility varies by state and by board.
3. Verify your malpractice insurance covers cross-state telehealth. Most policies do, but some restrict coverage by state. Call your carrier and confirm in writing.
4. Set up a registered agent if required. Florida and Arizona require designated agents with a physical in-state address. Commercial services typically charge $50–150 per year.
5. Document your dual-state practice in your informed consent. Clients should understand that you are registered (not fully licensed) in their state and what that means for the scope of services and emergency situations.
6. Maintain a clear policy for emergencies. If a client is in crisis and physically located in another state, you need a plan that complies with the state’s laws on duty to warn, mandated reporting, and crisis intervention.

A note on the regulatory direction

Two trends are shaping this space in 2026.

The first is the continued expansion of compacts. The Counseling Compact and Social Work Licensure Compact are both moving from legislative passage to operational implementation, which over the next 2-3 years will give the majority of behavioral health clinicians a true portable license model. For LPCs and counselors in particular, the compact path will likely become the dominant interstate practice mechanism.

The second is the consolidation of telehealth registration into a small number of well-functioning state programs. Florida’s program continues to mature. Colorado’s 2026 framework is the most recent significant addition. Other states are watching these models — and watching the compacts — before deciding whether to build their own.

For now, telehealth-only registration is most useful as a precise tool for a specific situation: a small number of clients in a specific state where full licensure is overkill and your profession’s compact doesn’t yet apply.

Quick reference: states with current telehealth registration pathways for therapists

• Florida — Out-of-State Telehealth Provider Registration. Behavioral health eligible: LCSW, LMHC, LMFT, Psychologist. Most established; requires registered agent.
• Arizona — Telehealth Registry. Behavioral health eligible: LCSW, LMFT, LPC, LISAC, Psychologist. Under 10 encounters per year exempt; PSYPACT supersedes for psychologists.
• Vermont — Telehealth Registration. Limited scope, varies by profession. Best for low-volume continuity of care.
• Colorado — Telehealth Provider Registration (effective 1/1/26). Behavioral health eligible: Psychologist, MFT, LCSW, LPC, Addiction Counselor. Newest; broad eligibility.
• Delaware — Out-of-State Mental Health Telehealth Registration. Specifically allows mental health, behavioral health, and social workers. Best for mid-Atlantic-focused practices.

Final note

Telehealth-only registration is one of the most useful but most misunderstood tools in cross-state therapy practice. It exists in a small number of states, but in those states it can save you months and thousands of dollars compared to full licensure. The trick is knowing which states genuinely offer it for your profession and which don’t.

For most therapists, the right strategy is a hybrid: pursue compact authorization where your profession has one, use telehealth registration for the handful of states where it makes sense, and pursue full licensure only when neither option fits and the volume of clients justifies the cost.

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