Virtual Therapist (LICSW, LADC, or LCMHC) - New Hampshire License Required at Iris Telehealth for Providers

First Name *

Last Name

Email *

Phone *

Resume *

Do you have a valid independent LICSW, LADC, or LCMHC license in New Hampshire? *

Have you passed the ASWB, NCW, and/or NCMHCE examination to gain clinical licensure? This is a mandatory requirement. *

Please enter the month and year you obtained your independent LICSW, LADC, or LCMHC license (e.g., MM/YYYY): *

Please list the state(s) in which you have an active, independent LICSW, LADC, or LCMHC license. *

Application Form