Remote Outpatient Therapist (LICSW / LPCC) – Minnesota at Iris Telehealth for Providers

First Name *

Last Name

Email *

Phone *

Resume *

Do you have a valid independent LICSW or LPCC license in Minnesota? *

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 or LPCC license (e.g., MM/YYYY): *

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

Application Form