Licensed Clinical Social Worker (LCSW) - Indiana license required at Iris Telehealth for Providers

First Name *

Last Name

Email *

Phone *

Resume *

Do you have a valid independent LCSW license in Indiana? *

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

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

Application Form