LPC Licensure
      

 LPC Application and Other Forms
 Sections on this page:

   Forms for LPC Licensure Applicants

   Forms for LPC Supervisors

   Forms for LPC Licensees

 

IMPORTANT: Beginning January 1, 2010, a $25 surcharge (10% of the initial license fee) is being assessed on every new application for licensure received at the BBHT.  The fee is being collected for the Minnesota Office of Enterprise Technology (OET), pursuant to Minnesota Statutes, section 16E.22.  It will be used to fund a State wide electronic licensing system.  To read more about the surcharge, please visit our webpage, titled, "OET Licensing Surcharge on New Licenses and License Renewals."
      

 Forms for LPC Licensure Applicants
 TitleOwnerCategoryLast UpdatedSize (Kb) 
LPC Application for Licensure Carly Lykes 1/10/2012 139.95 Download
LPC Form to Amend License Application   9/30/2008 32.85 Download
LPC Name and Address Change Form Carly Lykes 6/3/2011 48.51 Download
Variance to Rule Request Form   10/23/2009 184.75 Download
      

 Forms for LPC Supervisors
      

 Forms for LPC Licensees
 TitleOwnerCategoryLast UpdatedSize (Kb) 
LPC Individual Application for CE Approval Form   11/19/2007 31.82 Download
LPC License Verification Request Form   11/19/2007 35.96 Download
LPC Name and Address Change Form Carly Lykes 6/3/2011 48.51 Download
LPC Supervision Plan Change   3/16/2009 26.27 Download
Request for a Duplicate License Certificate   3/26/2009 40.80 Download
Variance to Rule Request Form   10/23/2009 184.75 Download
      

LPC Application & Other Forms  |  Levels of Licensure for Professional Counselors  |  Examination for Professional Counselors  |  LPC Application Process  |  LPC Application Requirements  |  LPC Required Coursework Guide  |  LPC Licensure by Reciprocity  |  Experienced Counselor Transition  |  LPC Professional Supervision  |  LPC & LPCC Code of Conduct (Ethics)  |  LPC Scope of Practice  |  LPC Renewals  |  Third Party Reimbursement - 11.18.2005  |  Third Party Update - 4.12.2006 | Login |


2829 University Ave SE Suite 210, Minneapolis, MN 55414
(612) 617-2178 FAX (612) 617-2187
Hearing/Speech Relay: (800) 627-3529
Comments? email: bbht.board@state.mn.us



The Minnesota Board of Behavioral Health & Therapy is an affirmative action / equal opportunity employer.
The Minnesota Board of Behavioral Health & Therapy does not discriminate in employment on the basis of race, color,
creed, religion, national origin, sex, marital status, disability, public assistance, age, sexual orientation, or
membership on a local human rights commission.