Most states require therapists to be licensed wherever their client is physically located during a session, not where the therapist sits. This means practicing therapy across state lines typically requires some form of authorization in the client’s state. The good news: a growing patchwork of interstate compacts, telehealth registrations, and temporary practice rules now make cross-state therapy possible in many parts of the country, depending on your license type.
Why State Lines Matter for Telehealth Therapy
Therapy delivered by telehealth is legally considered to take place where the client is at the time of the session. Alabama, Colorado, Louisiana, West Virginia, and South Carolina all have statutes making this explicit, and virtually every other state follows the same principle. If you’re a therapist in Oregon and your client logs in from a hotel room in Texas, you’re practicing in Texas for legal purposes. If your long-time client moves to a new state for a job, you generally can’t keep seeing them without authorization in their new state.
This rule applies regardless of the therapist’s license type: psychologists, licensed professional counselors, clinical social workers, and marriage and family therapists all face the same basic requirement. The mechanisms for getting that authorization, however, vary significantly by profession.
PSYPACT for Psychologists
The Psychology Interjurisdictional Compact, known as PSYPACT, is the most established interstate compact for therapy. It allows licensed psychologists to practice telepsychology across any participating state without obtaining a separate license in each one. Psychologists apply through PSYPACT for an Authority to Practice Interjurisdictional Telepsychology (APIT), which then covers them in all member states at once.
As of 2025, the majority of U.S. states and territories have enacted PSYPACT. Notable holdouts with legislation currently pending include Alaska, Hawaii, Iowa, Louisiana, Massachusetts, and New York. If your psychologist holds an APIT credential and you live in a PSYPACT state, cross-state sessions are straightforward. You can check the current map at psypact.gov to confirm whether your specific state is active.
The Counseling Compact for LPCs
Licensed professional counselors have a newer option: the Counseling Compact. While dozens of states have passed legislation to join, the compact is still in its early operational phase. As of early 2025, the compact is live and actively issuing privileges only between Arizona, Minnesota, and Ohio. Counselors licensed in those states can apply to practice in the other participating states.
This means that for most LPCs in most states, the Counseling Compact isn’t yet a practical solution. Many states have enacted the legislation but haven’t reached the implementation stage where they’re actually issuing privileges. The compact is expected to expand significantly over the next few years as more states come online, but right now the pool of states where it functionally works is very small.
Marriage and Family Therapists
Marriage and family therapists don’t yet have an interstate compact. Instead, the American Association for Marriage and Family Therapy has pushed for “portability-friendly” licensure laws that make it easier for MFTs to get licensed in a new state by endorsement, meaning their existing license and credentials are accepted without having to repeat exams or meet substantially different requirements.
A large number of states are now considered portability-friendly for MFTs, spanning most of the country. This doesn’t eliminate the need to apply for a license in the client’s state, but it reduces the process from months of paperwork to a more streamlined endorsement application. If you’re an MFT looking to treat clients in another state, check that state’s board for licensure by endorsement options.
States With Telehealth Registration Programs
Some states have created a middle path: a telehealth-specific registration that’s faster and simpler than full licensure. These programs let out-of-state therapists treat clients in that state via telehealth without going through the full licensing process.
Florida
Florida offers an out-of-state telehealth provider registration at no cost. To qualify, you need an active, unencumbered license from another state, no disciplinary actions in the past five years, a registered agent for service of process in Florida, and liability coverage meeting Florida’s requirements. You cannot open a Florida office or see Florida clients in person. The registration covers psychologists, clinical social workers, licensed professional counselors, and marriage and family therapists.
Vermont
Vermont currently offers an Interim Telehealth Registration for out-of-state mental health professionals, including licensed clinical mental health counselors and marriage and family therapists. You register through the state’s Office of Professional Regulation and can then provide telehealth to clients in Vermont. Vermont is also developing a tiered permanent system: a Telehealth Registration (limited to 10 clients over 120 days, once every three years) and a Telehealth License (up to 20 clients over a two-year term, renewable). These permanent tiers aren’t yet in effect but will eventually replace the interim registration.
Other states have created similar registration pathways or expedited licensure tracks. The details change frequently as states update their telehealth laws, so checking the licensing board in the specific state where your client lives is always the most reliable step.
Temporary Practice Allowances
A few states allow brief, limited cross-state therapy under temporary practice rules. California, for example, offers a one-time, 30-consecutive-day temporary practice allowance per calendar year for out-of-state licensed marriage and family therapists, professional clinical counselors, and clinical social workers. The key limitation: it’s only for treating an existing client who is traveling in California, not for taking on new California-based clients. You get one 30-day window per year, and it can’t be split up or repeated.
These provisions are designed for continuity of care during travel, not for building a practice across state lines. They’re useful if your client is temporarily away from home, but they won’t help if someone permanently relocates.
How Insurance Handles Cross-State Sessions
Even when you have legal authorization to practice across state lines, insurance reimbursement adds another layer. Insurers generally require that the provider meet the licensing requirements of the state where the client is physically located at the time of the session. BlueCross BlueShield policies, for example, specify that a telehealth encounter must satisfy the rules of the “relevant healthcare regulatory board of the state where the patient is physically located.”
Approved clinician types for telehealth reimbursement typically include psychologists, clinical social workers, licensed professional counselors, and marriage and family therapists. But each plan and each state can have different rules about which telehealth services are covered and what documentation is needed. If you’re a client, it’s worth confirming with your insurer that your specific cross-state arrangement will be reimbursed before your first session.
Practical Steps for Clients and Therapists
If you’re a client hoping to continue therapy after a move or while traveling, start by asking your therapist whether they hold any authorization to practice in your new state. If they’re a psychologist, PSYPACT may cover you immediately. For other license types, the options are more limited and state-specific.
If your therapist can’t follow you across state lines, ask for a referral to a provider licensed in your new state. Many therapists will also do a warm handoff, sharing treatment notes (with your consent) and even joining an introductory session with your new provider to ease the transition.
If you’re a therapist looking to expand your practice across state lines, the fastest path depends on your license type. Psychologists should look at PSYPACT. Licensed professional counselors should check whether their state and the target state are both actively issuing privileges under the Counseling Compact. MFTs should explore endorsement-based licensure in the target state. And for any license type, check whether the client’s state offers a telehealth registration program that could get you practicing there without full licensure.