The short answer
Generally only if you're licensed, or hold a compact privilege, in the state where the client is physically located during the session. Your location matters less than theirs. Some states allow limited temporary practice or continuity of care for traveling clients, so check the rules of the state the client is in.
Which state's license do you need for telehealth?
The state where the client is physically located during the session. That's the general rule across states and professions. If a client lives in Missouri but is on vacation in Colorado, Colorado's rules apply to that session.
Your own location matters less, though your home state may have rules too.
How do you handle it in practice?
- Ask where the client is at the start of every session, and document it.
- Explain the rule in informed consent so clients know to tell you before traveling.
- Plan ahead for known trips: reschedule, check the other state's rules, or arrange a temporary handoff.
A Psychology Today article on teletherapy and client location makes the point bluntly: not asking isn't a defense.
Are there exceptions?
Some states allow:
- Temporary practice for a limited number of days by clinicians licensed elsewhere.
- Continuity of care for existing clients who are temporarily in the state.
- Registration for out-of-state telehealth providers.
The rules differ by state and profession, and they change. Check the licensing board of the state where the client is located.
How do compacts change this?
Interstate compacts let licensed clinicians practice in other member states without full new licenses:
- PSYPACT for psychologists, already widely used for telepsychology.
- The Counseling Compact for professional counselors, issuing privileges in a growing number of states.
- The Social Work Licensure Compact, not yet issuing multistate licenses.
See Counseling Compact, PSYPACT, and the Social Work Compact.
Do VA programs change the rule?
Not for community therapists. CHAMPVA and VA Community Care pay licensed providers, and state licensure rules still decide where you can practice. VA's own employees work under separate federal authority.
How ValorWell handles this
ValorWell matches therapists with clients located in the states where they're licensed. ValorWell needs therapists in every state, and may support additional state licenses case by case, depending on need. Confirming the client's location each session is part of your normal practice.
Important limits
- This isn't legal advice. State rules vary and change; check with the board in the client's state.
- Malpractice should cover every state where you see clients.
- Emergency planning depends on location. Know local resources for wherever the client is.