Outpatient Therapist (LICSW / LIMHP) - Nebraska license preferred at Iris Telehealth for Providers

First Name *

Last Name

Email *

Phone *

Resume *

Do you have a valid independent LIMPH or LICSW license in Nebraska? *

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

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

Application Form