What is an interstate licensure compact?

An interstate licensure compact is a legal agreement between states that allows licensed healthcare professionals to practice in multiple member states under a single license or expedited privilege. Compacts do not eliminate individual state licenses — they streamline the process of obtaining and maintaining them. Each compact has its own eligibility requirements, participating states, and scope of coverage.

Do I still need a separate license in each state under a compact?

It depends on the compact. Some compacts (like the NLC for nurses) issue a single multistate license that covers all participating states. Others (like the IMLC for physicians) expedite the process of obtaining individual state licenses but still require a separate license per state. Review the specific compact rules for your profession before assuming coverage.

Which compact covers physicians for multi-state practice?

The Interstate Medical Licensure Compact (IMLC), administered by the IMLC Commission, covers MDs and DOs. The IMLC is an expedited pathway — it does not replace individual state licenses. Physicians must still hold a license in each state where they practice, but the IMLC dramatically reduces the time and paperwork required to obtain those licenses. Verify current member states at imlcc.com.

Can nurse practitioners use the Nurse Licensure Compact (NLC)?

No. The NLC covers RNs and LPNs only. Nurse practitioners (APRNs) have a separate compact — the APRN Compact — which as of mid-2026 has only four enacted jurisdictions and is not yet operational. Until the APRN Compact becomes operational, APRNs generally must obtain the required authority or license in each patient state unless another state-specific exception applies.

What is PSYPACT and who does it cover?

PSYPACT (Psychology Interjurisdictional Compact) allows licensed psychologists to provide telepsychology services (APIT) and temporary in-person practice (TAP) across participating states. Psychologists must apply for the relevant authority through PSYPACT — it is not automatic upon licensure. State participation is expanding; verify the current map at psypact.gov.

Do telehealth providers need to be licensed in the patient's state?

Yes. Regardless of compact membership, telehealth providers must be licensed in the state where the patient is physically located at the time of the encounter — not where the provider is located. This is a fundamental rule of telehealth compliance. Multi-state telehealth practices must obtain and maintain licenses in every state where they see patients.

What is the difference between a compact privilege and a compact license?

A compact license (like the NLC multistate license) is a single license that grants practice rights in all participating states. A compact privilege is an authorization to practice in a specific compact state, granted on top of your home state license. Most allied health compacts use the privilege model — you hold your home state license and apply for privileges in additional states.

What does "Implementing" status mean?

Implementing means the compact has been enacted or activated by the required number of states, but the commission, interstate data system, licensing rules, or privilege-issuance process is not yet fully operational. Practitioners in an implementing compact generally cannot yet obtain or use compact privileges. Always verify current operational status directly with the compact administrator.

Can I prescribe controlled substances across state lines via telehealth?

Controlled substance prescribing via telehealth is governed by the Ryan Haight Act, DEA regulations, and individual state laws. The DEA Special Registration for Telemedicine provides pathways for prescribing certain controlled substances via telehealth without a prior in-person evaluation. State laws add additional requirements. Consult current DEA guidance and a healthcare attorney before prescribing controlled substances via telehealth.

What should healthcare startups know about multi-state licensure?

Healthcare startups planning multi-state operations should budget for licensure costs in every target state, build a credentialing timeline that accounts for 60–180 day processing windows, and consider using a credentialing service or medical director with existing multi-state licenses. Compact membership can significantly reduce time-to-market in participating states, but only where privileges are currently operational. Always verify compact participation and eligibility requirements before assuming coverage.

Resource Center — Licensure

Multi-State Healthcare Licensure

Complete reference for interstate licensure compacts across 19 healthcare professions. Know which compacts are active, which are still implementing, and what each covers — so you can build a compliant multi-state practice.

Last Updated: August 7, 2026 · Always verify current state participation at each compact's official website

10+

Active Compacts

Professions Covered

NLC Jurisdictions

44+

IMLC Members

Important — verify before you rely. Interstate compact participation, implementation status, licensing requirements, scope-of-practice rules, telehealth requirements, prescribing authority, supervision requirements, and eligibility standards change frequently. Always verify current requirements directly with the applicable compact commission and the relevant state licensing board before practicing or treating patients across state lines. This resource is provided for educational purposes and is not legal advice.

19 Professions — Compact Reference

Click any compact name to visit the official compact website (opens in new tab).

Profession	Compact	Participation	Status	Notes
MD/DO Physician (MD/DO)	Interstate Medical Licensure Compact (IMLC)	44 member states + 2 U.S. territories	Active	The IMLC provides an expedited pathway for eligible physicians to obtain individual licenses from participating states. It does not replace individual state medical licenses — a separate license is still required in each state where the physician practices. Home state must participate. Subspecialty restrictions may apply. Verify current member states at imlcc.com.
NP/APRN Nurse Practitioner / APRN	APRN Compact	4 enacted jurisdictions (DE, ND, SD, UT)	Pending Activation	The APRN Compact requires seven states to enact the legislation before it becomes operational. As of mid-2026, four jurisdictions have enacted it: Delaware, North Dakota, South Dakota, and Utah. The compact is NOT YET OPERATIONAL. The Nurse Licensure Compact (NLC) does not authorize APRN/NP practice. Until the APRN Compact becomes operational, APRNs generally must obtain the required authority or license in each patient state unless another state-specific exception applies. Verify current status at aprncompact.com.
RN Registered Nurse (RN)	Nurse Licensure Compact (NLC)	43 participating jurisdictions	Active	One of the most mature compacts. Covers RNs and LPNs/LVNs under a single multistate license. Primary state of residence determines compact eligibility. The NLC does not itself authorize APRN practice. Verify current participating jurisdictions at nursecompact.com.
LPN/LVN Licensed Practical Nurse (LPN)	Nurse Licensure Compact (NLC)	43 participating jurisdictions	Active	Covered under the same NLC as RNs. LVN designation used in California and Texas. The NLC does not itself authorize APRN practice.
PA-C Physician Assistant (PA)	PA Compact	26 member states Compact privileges not yet available	Implementing	PA Compact privileges are currently projected to become available in early 2027. Membership in the compact does not mean PAs can currently begin practicing across all member states. PAs must hold an active license in their home state. Verify current status and member states at pacompact.org.
PhD/PsyD Psychologist	Psychology Interjurisdictional Compact (PSYPACT)	Verify current PSYPACT map at psypact.gov	Active	PSYPACT provides two separate authorities: the Authority to Practice Interjurisdictional Telepsychology (APIT) and the Temporary Authorization to Practice (TAP) for in-person services. Participation does not apply automatically — psychologists must apply through PSYPACT. State participation is expanding; Alaska and Iowa enacted legislation in 2026. Verify the current participating-jurisdiction map directly at psypact.gov before assuming coverage.
LPC/LMHC Licensed Counselor (LPC/LMHC)	Counseling Compact	Multiple states enacted; verify live states at counselingcompact.gov Privileges currently operational in AZ, GA, IN, LA, MN, OH (as of June 2026)	Implementing	Multiple states have enacted the Counseling Compact. Compact privileges are currently operational in a smaller group of states — Arizona, Georgia, Indiana, Louisiana, Minnesota, and Ohio as of June 2026. Other member states remain in implementation. Verify the live-state list at counselingcompact.gov before assuming privilege availability.
LMFT Marriage & Family Therapist (LMFT)	No general Counseling Compact pathway for LMFTs	Verify state-by-state	No Compact	LMFT licensure is generally separate from the Counseling Compact. The Counseling Compact specifically states that LMFTs and LCSWs are typically not eligible unless they independently satisfy the compact's LPC eligibility requirements. LMFTs should verify interstate practice options with their home-state licensing board and the destination state. There is no general LMFT interstate compact at this time.
LCSW/LMSW Licensed Clinical Social Worker (LCSW)	Social Work Licensure Compact	35 states enacted (as of July 2026) Multistate licenses not yet being issued	Implementing	The Social Work Licensure Compact has reached activation status, but multistate licenses are not yet being issued. Implementation and the interstate data system remain underway. Enacted membership does not immediately authorize interstate practice. Verify current status at swcompact.org.
PT/PTA Physical Therapist (PT)	Physical Therapy Licensure Compact (PT Compact)	Verify current participation at ptcompact.org	Active	One of the most widely adopted allied health compacts. Covers PTs and PTAs. Compact membership and obtaining a compact privilege for a remote state are separate steps — membership alone does not authorize practice in another state. Telehealth and in-person practice covered. Verify current participating states and privilege availability at ptcompact.org.
OT/OTA Occupational Therapist (OT)	Occupational Therapy Licensure Compact (OT Compact)	Verify current participation at otcompact.org	Implementing	The OT Compact is growing. Not every state that has enacted the compact is immediately operational for issuing privileges. Covers OTs and OTAs. Verify current member states and which states are currently issuing compact privileges at otcompact.org.
SLP/CCC-SLP Speech-Language Pathologist (SLP)	Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC)	Verify current participation at aslpcompact.com	Active	Covers both SLPs and audiologists under the same compact. Telehealth practice widely supported. Verify current participating states and operational status at aslpcompact.com before assuming coverage.
AuD/CCC-A Audiologist (AuD)	Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC)	Verify current participation at aslpcompact.com	Active	Covered under the same ASLP-IC compact as SLPs. Verify current participating states and operational status at aslpcompact.com.
EMT/Paramedic Emergency Medical Services (EMS)	Emergency Medical Services Personnel Licensure Interstate Compact (REPLICA)	28 enacted states Active in 25 states; Alaska, Arizona & Connecticut implementing	Active	EMS Compact Privilege to Practice requirements include applicable home-state licensure and other compact requirements. EMS personnel must comply with remote-state law and applicable EMS agency and medical-director requirements. 28 states have enacted the compact; 25 are currently active. Alaska, Arizona, and Connecticut have enacted legislation and are pending implementation. Verify current status at emscompact.gov.
DDS/DMD/RDH Dentist / Dental Hygienist	Dentist and Dental Hygienist Compact	At least 13 states enacted (as of May 2026) Compact privileges not yet being issued	Implementing	The compact covers dentists and dental hygienists. Compact privileges are not yet being issued. Verify current member states and implementation status at ddhcompact.org.
PharmD/RPh Pharmacist (PharmD)	Pharmacist Licensure Compact (PLC)	Verify current status at nabp.pharmacy	Implementing	Administered by NABP. Do not rely on any hardcoded state count — verify current PLC member states and operational status directly at nabp.pharmacy. Most pharmacists still require individual state licenses until compact privileges are fully operational.
RD/RDN Registered Dietitian (RD)	Dietitian Licensure Compact	Verify current participation at dietitianscompact.org Compact privileges not yet being issued	Implementing	The Dietitian Licensure Compact has been activated but compact privileges are not yet being issued. Enactment/activation does not mean privileges are immediately available. Important for telehealth nutrition counseling programs. Verify current participating states and implementation status at dietitianscompact.org. The Academy of Nutrition and Dietetics (EatRightPro) provides additional background at eatrightpro.org.
RRT/CRT Respiratory Therapist (RT)	Interstate compact status developing	Verify current state-specific requirements	Pending Activation	An operational interstate respiratory therapy compact cannot be independently verified at this time. Respiratory therapists should verify current state-specific licensure requirements directly with the applicable state licensing board and the AARC state advocacy resources. Do not rely on any hardcoded state count for an RT compact.
CMA/RMA Medical Assistant (MA)	No formal interstate compact	No compact — state-by-state requirements apply	No Compact	There is currently no general interstate medical-assistant licensure compact. National certification such as CMA (AAMA) or RMA does not override state-specific scope-of-practice, registration, delegation, supervision, or licensing requirements. Medical assistants must verify requirements in each state where they practice.

Active — practitioners can currently obtain/use compact privileges

Implementing — compact enacted but privileges not yet fully operational

Pending Activation — has not yet reached required member-state threshold

No Compact — no applicable interstate compact currently exists

Need Help Navigating Multi-State Licensure for Your Practice?

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How to Obtain Multi-State Licensure

The general process is similar across most compacts — always verify the specific steps with your compact's administrator.

Find your compact

Use the table above to identify the applicable interstate compact for your profession and visit its official website.

Verify state participation

Confirm your home state and target states are current compact members. Participation changes as new legislation passes.

Check eligibility

Each compact requires an active home state license, clean disciplinary history, and sometimes minimum practice hours.

Apply through the compact

Submit your application via the compact's official portal. Processing times range from days to several weeks.

Maintain compliance

Compact privileges require ongoing compliance with each state's CE requirements, scope of practice rules, and disciplinary reporting.

Key Compacts at a Glance

The most widely used compacts for healthcare startups and multi-state telehealth practices.

IMLC — Physicians

MDs and DOs

44+ jurisdictions

Expedited pathway to obtain individual state licenses — does not replace individual state licenses. Home state must participate. Fastest path to multi-state physician licensure.

Official website

NLC — RNs & LPNs

Registered Nurses, Licensed Practical Nurses

43 jurisdictions

Single multistate license. Most mature compact. Primary state of residence determines eligibility. Does NOT cover NPs/APRNs.

Official website

APRN Compact — NPs

Nurse Practitioners, CRNAs, CNMs, CNSs

4 enacted — NOT YET OPERATIONAL

Requires 7 states to activate. As of mid-2026 only 4 jurisdictions have enacted it. NPs must obtain individual licenses in each patient state until the compact becomes operational.

Official website

PSYPACT — Psychologists

Licensed Psychologists

Verify at psypact.gov

Covers telepsychology (APIT) and temporary in-person practice (TAP). Must apply separately — not automatic upon licensure. Verify current participating states at psypact.gov.

Official website

PT Compact

Physical Therapists, Physical Therapist Assistants

Verify at ptcompact.org

Compact privilege model. One of the most widely adopted allied health compacts. Covers both in-person and telehealth PT. Compact membership and obtaining a privilege are separate steps.

Official website

PA Compact

Physician Assistants (PA-C)

26 member states — privileges not yet available

Compact privileges projected to become available in early 2027. Membership does not mean PAs can currently practice across member states. Verify current status at pacompact.org.

Official website

Frequently Asked Questions

Common questions about interstate licensure compacts and multi-state healthcare practice.

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