Private Practice Setup Checklist for New Therapists (2026)
Private practice is appealing for obvious reasons: schedule control, clinical autonomy, and income potential that most agency jobs can’t match. It’s also a real business, with real operational requirements that most graduate programs don’t teach.
This checklist is designed to get you from “thinking about it” to “seeing clients” without skipping the steps that create legal or clinical risk. Work through it sequentially — the order matters.
Part 1: Licensing and Legal Structure
☐ Verify your license is current and unrestricted
Log into your state licensing board’s website and confirm your license status. If you’re a supervisee, confirm your supervision arrangement is documented and compliant with state requirements before you see a single private pay client.
☐ Know your scope and restrictions
Some states restrict telehealth, out-of-state practice, or specific treatment modalities for unlicensed clinicians. Know what your license allows before you build a practice around it.
☐ Choose a business entity
Register through your state Secretary of State website. This is generally a 15-minute online process.
☐ Get an EIN (Employer Identification Number)
Free from IRS.gov. You’ll need this to open a business bank account and for tax purposes. Apply at IRS.gov/EIN — takes about 10 minutes.
☐ Open a dedicated business bank account
From day one, business finances go in one account and personal finances go in another. Commingling is the most common bookkeeping mistake new practice owners make and creates real problems at tax time.
☐ Register your NPI (if you don’t have one)
Your National Provider Identifier is required for insurance billing and many credentialing applications. Register free at NPPES.nanus.cms.hhs.gov.
Part 2: Insurance and Liability
☐ Obtain malpractice insurance before seeing clients
Non-negotiable. You need professional liability coverage before your first session. Compare:
Budget $400–$800/year for solo therapist coverage.
☐ Decide whether to join insurance panels
This is one of the biggest decisions in private practice setup.
In-network pros: Built-in referral flow, lower barrier for clients, faster caseload growth.
In-network cons: Lower reimbursement rates (often $80–$110/hour vs. $150–$200+ private pay), more administrative work, credentialing delays.
Private pay pros: Higher rates, less paperwork, more clinical freedom.
Private pay cons: Smaller client pool, requires more active marketing.
Many new therapists start with 1–2 insurance panels and supplement with private pay. This provides income stability while building a caseload.
☐ Complete CAQH profile (if going in-network)
CAQH is the centralized credentialing database most major insurers use. Complete your profile at caqh.org before contacting individual payers. Allow 60–120 days for panel approval — apply before you plan to open.
☐ Identify your fee schedule
Research market rates in your area. Consider:
Set your rates with intention. Underpricing is common among new therapists and creates financial stress that affects clinical work.
Part 3: HIPAA and Compliance
☐ Select a HIPAA-compliant EHR
You need a platform that can manage client records, scheduling, billing, and client communication — all in a HIPAA-compliant environment. Leading options for solo therapists:
Choose before you see your first client. Set up your client portal and intake workflow before opening your calendar.
☐ Sign a BAA with every vendor who handles PHI
A Business Associate Agreement (BAA) is legally required under HIPAA with any vendor who has access to protected health information. This includes your EHR, video platform, email provider, and billing service.
Common HIPAA-compliant platforms that provide BAAs: Google Workspace for Business, Zoom for Healthcare, SimplePractice, Spruce Health. Personal Gmail and standard Zoom do not qualify.
☐ Create your core intake documents
At minimum:
Most EHR platforms include templates. Customize them to your practice and have a licensed attorney review if possible.
☐ Set up a HIPAA-compliant phone line
Don’t use your personal cell for client calls. Options:
Part 4: Office and Technology
☐ Decide on your practice model
☐ Secure office space (if seeing clients in person)
Options in roughly ascending cost order:
1. Sublet from another therapist — often $300–$700/month for part-time use
2. Shared therapy suite — rent a room in a multi-clinician office
3. Coworking space — verify HIPAA suitability before committing
4. Your own commercial lease — more control, more cost; best once you have stable caseload
☐ Test your technology
Before your first session:
Part 5: Marketing and Client Acquisition
☐ Create a Psychology Today profile
The most-visited therapist directory. Approximately $30/month. Write your profile for your ideal client — what they’re struggling with, how you help, what working with you is like. Not a credentials list.
☐ List on additional directories
☐ Build a simple website
Essential elements:
Don’t overthink it. A clean one-page site beats a complex site you’ll never finish building.
☐ Identify your niche and write a clear positioning statement
“I help [specific population] who are struggling with [specific problem] to [specific outcome].”
Example: “I help adults navigating burnout and career transitions find clarity about what they actually want and how to get there.”
A defined niche makes directories, referrals, and your website dramatically more effective.
☐ Activate your referral network
Reach out to:
Most early caseloads come through direct referral, not directories.
Pre-Opening Final Check
Before scheduling your first client, confirm:
Private practice is built incrementally. You don’t have to have everything perfect before you see your first client — you have to have the essentials in place and a plan for the rest. Work through this list systematically and you’ll open your doors with a solid foundation.
TherapistDesk has deeper resources on each stage of this process — from HIPAA compliance to marketing your niche to navigating insurance credentialing.