Provisionally Licensed Mental Health Practitioner (PLMHP) Requirements

Provisionally Licensed Mental Health Practitioner is a person who needs to obtain the required 3,000 hours of supervised experience in mental health practice to qualify for a mental health practitioner license.

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burgundy ball Applications
burgandyball.jpg Conditions of Provisional License
burgandyball.jpg Expiration
burgandyball.jpg Issuance and Processing Time
burgandyball.jpg Misdemeanor/Felony Convictions or Licensure Discipline
burgandyball.jpg Provisional License Requirements and Application Process
burgandyball.jpg Supervisor Changes

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Provisional License Requirements and Application Process

See PDF File 172 NAC 94-004

To qualify for a provisional mental health practitioner license (if earning experience in Nebraska), you must submit a completed PDF File application to:

Licensure Unit
PO Box 94986
Lincoln, NE 68509-4986

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Conditions of the Provisional License:

A mental health practitioner practicing with a provisional license shall:

    • Practice under supervision of a Licensed Mental Health Practitioner (LMHP), Licensed Psychologist, or qualified physician;
    • Use the title Provisionally Licensed Mental Health Practitioner (PLMHP);
    • Shall inform all clients that he or she holds a provisional license and is practicing mental health under supervision and shall identify the supervisor. Failure to make such disclosure is a ground for discipline as set forth in Neb.Rev.Stat. § 38-178 of the PDF File Uniform Credentialing Act;
    • Not supervise other provisionally licensed mental health practitioners; and
    • Notify the Department when a change in supervisor(s) occurs.

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Supervisor Changes

Supervision includes a total of 3,000 hours:

  • a minimum of at least 1,500 hours of direct client contact in a setting where mental health services were being offered
  • the remaining hours include, but are not limited to, review of client records, case conferences, direct observation, and video observation.

Supervision means monitored by:

  • (prior to 9/1/94) a qualified physician, a licensed clinical psychologist, or a certified master social worker, certified professional counselor, or marriage and family therapist qualified for certification on 9/1/94; or
  • (after 9/1/94) a qualified physician, a psychologist licensed to engage in the practice of psychology, or a licensed mental health practitioner for any hours completed after 9/1/94, including evaluative face-to-face contact for a minimum of 1 hour per week

Change in Supervisor or Adding a Supervisor: If a change in supervisor(s) occurs or you wish to add a supervisor, you must submit an PDF File application for such change or addition no later than 30 days following the change.

Termination of Supervision: If you or your supervisor terminates supervision, your supervisor should submit a letter to this affect and also state the date such termination occurred.

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Issuance and Processing Time:

If the PDF File application is complete, issuance of the provisional license usually occurs within approximately 3 weeks. By statute the Department must act within 150 days upon receipt of a completed application.

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Applications

Currently, two of the forms (indicated by an *) may be completed on-line, however, they cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form on-line, you must print the form and mail it to the address below.

All materials shall be submitted to Licensure Unit with fee payable to the "Licensure Unit".

Licensure Unit
PO Box 94986
Lincoln, NE 68509-4986

* PDF File Provisional License/Certificate - you may complete on-line, print and mail.
    PDF File Change in Supervisor of a Provisional License/Certificate

   

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Expiration:

A provisional license to practice mental health expires upon receipt of a license to practice mental health or 5 years after the date of issuance, whichever occurs first; and expires upon a change in supervisor(s) or termination of supervision.

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Misdemeanor/Felony Convictions or Licensure Discipline

If you had a misdemeanor or felony conviction or had your license in any health care profession in another state revoked, suspended, limited or disciplined in any manner, you must request the following documents be sent directly to this office:

  • Official Court Record, which includes charges and disposition;
  • If the conviction involved a drug and/or alcohol related offense, all addiction/mental health evaluations and proof of treatment (if treatment was obtained and/or required);
  • If you are currently on probation, a letter from your probation officer addressing probationary conditions and your current status; and
  • If your license in health care in another state has been revoked, suspended, limited or disciplined in any way, an official copy of the disciplinary action, including charges and disposition.

NOTE: If you have any criminal charges or license disciplinary actions pending that results in conviction or license discipline, you are required to report such actions to this department within 30 days.

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