Most guides to starting a private practice begin with forming an LLC. That is roughly like beginning a guide to running a marathon with what shoes to buy. It's on the list, it's not the thing that decides the outcome, and starting there is how people end up with a registered business and no idea whether the business works.
Here is the sequence as it actually runs in Florida, including the parts that are legally impossible before a certain point, and the number that everything else depends on.
Intern usually means a graduate student completing practicum or internship hours before they finish their degree. Still in school.
RMHCI — Registered Mental Health Counselor Intern — is a post-master's clinician registered with the Board and accruing supervised experience toward licensure. Not a student. Registered, and not described as licensed. The statute calls this person a "registered intern," which is where most of the confusion comes from.
LMHC is licensed. Independent practice starts here.
Anyone telling an RMHCI they're "basically licensed" or "just an intern" is wrong in opposite directions, and the difference determines what you're allowed to do.
You can work in private practice as an RMHCI. What you cannot do is practice independently — a solo practice you own and run on your own is not available until licensure.
The common structure is contracting as a 1099 with an agency or an established private practice. That gets you private-practice work, private-practice pay structures, and experience of the business, while the supervision and oversight requirements are met by the practice you're contracting with.
The premises rule still applies to that arrangement. Under s. 491.005(4)(c), F.S., a licensed mental health professional must be on the premises when a registered intern provides clinical services in a private practice setting. Being a 1099 rather than a W-2 changes your tax treatment and your autonomy — it does not change that requirement. This is the single most commonly violated rule in the field, usually by RMHCIs seeing telehealth clients from home under a private-practice contract, and usually with no idea they're out of compliance.
The foundational starting point
If you take one thing from this page, take this. The foundation is not your entity, your website, your niche, or your EHR.
The foundation is knowing what one session actually pays you, and how many of them you need.
Not your rate. What lands in your account after the reimbursement is what it is rather than what you billed, after the no-show that didn't get filled, after the percentage that goes to self-employment tax, after the share of every session that pays your overhead. Therapists routinely start practices on the arithmetic of "my rate times my caseload" and discover eighteen months in that the real figure is roughly half of that.
Work that number out before you form anything. It tells you your rate, whether you can take insurance, how many clients a week you need, how much runway to save, and whether the whole idea is viable at the caseload you can actually sustain. Every other decision on this page is downstream of it.
Work out your number
Change any figure and the answer updates. Nothing is sent anywhere — this runs in your browser.
The five phases
Each one opens. The headline under each phase is the whole point of it — expand only what you need right now.
0While you're an RMHCI You can't own a practice yet, but you can 1099 into one. These two to three years are your apprenticeship in the business — and almost nobody uses them that way.+
Choose the job for the caseload, not the title
Your hours are the currency. A heavy direct-service role gets you licensed faster than a prestigious one full of meetings. Ask for the expected weekly face-to-face number in the interview.
Treat wherever you land as an apprenticeship
You're inside a functioning mental health business. Watch the parts you'll have to replace: how intakes get scheduled, what happens when a claim is denied, whether the no-show policy is actually enforced, why some referral sources send and others don't. This is free education you'll otherwise buy from a consultant.
Start the relationships now
Referral relationships take years and can't be bought at launch. The psychiatrists, pediatricians, school counselors and attorneys who'll fill your caseload should know your name long before you need them.
Let the niche find you
Niche isn't a launch decision, it's an observation. Notice which clients you do unusually good work with and which drain you. That pattern is more honest than anything you'd pick off a list.
Build the runway
The best predictor of whether a new practice survives is how long the owner can go without it paying them. Save while you have a steady paycheck.
Still need a qualified supervisor?
MT provides clinical supervision for licensure candidates — the hours, the documentation, and a supervisor who has actually run the kind of practice you're heading toward. If you're between placements or your current supervision is unreliable, this is the gap we fill.
Ask about supervision →1Newly licensed, still employed The question isn't “am I ready.” It's “what exactly am I replacing?” Most people price the salary and forget the health insurance, the referral pipeline, the billing they never see, and the colleague down the hall.+
A salaried job is not just the salary. It's benefits, PTO, someone else's malpractice, a referral pipeline you didn't build, an EHR you didn't choose, and billing that happens invisibly. Leaving means buying all of it back.
The bridge is usually the right answer
The path that most often works isn't a leap. It's reduced hours at the day job while you build evenings and one weekday, until the practice makes the job optional. Slower, less romantic, dramatically more survivable.
Read your employment agreement first
Do this with a lawyer, before you tell anyone you're leaving. Non-compete radius, non-solicitation of clients and staff, and any claim your employer makes to work product or referral sources. Enforceability is genuinely nuanced — get a real answer, not a Facebook group's.
Pressure-test the decision before you make it
We've helped launch more than 200 practices, which means we've watched this decision go well and badly a lot of times. Business coaching is an hour spent on your actual numbers, your actual contract, and your actual market — before you resign, not after.
Book a conversation →2The business bones Entity, EIN, Type 2 NPI, CAQH, malpractice, EHR — and several of these block the ones after them, which is why the order matters more than the speed.+
Working through these? The practice setup checklist turns this table into 14 tickable steps with the actual links, costs and timeframes — and remembers where you got to.
| Step | Why it's here |
|---|---|
| Entity + EIN | Sole proprietorship vs LLC vs professional entity is a legal and tax question about your situation. Talk to a CPA and an attorney — not a blog. |
| NPI — both types | You have a Type 1 (individual). Your business needs a Type 2 (organizational). Free, fast, required for credentialing, and a very common thing to discover missing three weeks into a payer application. |
| Malpractice | Your employer's policy doesn't follow you. Check claims-made vs occurrence, and whether you need tail coverage for the old job. |
| Business address | Working from home makes your address public record. A registered agent or virtual address is cheap; your home address in a payer directory is permanent. |
| Bank account | Separate from personal, day one. The difference between an hour with your CPA and a weekend of forensic accounting. |
| CAQH profile | The shared database most payers pull from. Complete and attest before applying anywhere — a stale profile stalls applications silently. |
| EHR | Choose for billing and claim handling, not note templates. You'll write notes in anything; you'll fight with billing weekly. |
| HIPAA in practice | Signed BAAs with every vendor touching client data, a documented security risk analysis, written policies. It's what an investigation asks for. |
Get the sequence right the first time
None of this is hard. All of it is easy to do in the wrong order, and the wrong order costs months. We set this up for clinicians every week — entity, NPIs, CAQH, payer-ready from the start — so that when you apply to panels, nothing bounces back.
Get set up properly →3Getting paid Credentialing runs 90–180 days and can't start until the business exists. Resign first and you'll spend six months with no insurance revenue. This is where new practices actually fail, and it's a sequencing problem, not a clinical one.+
Private pay or insurance
Private pay: higher rate, no credentialing wait, no claims — but you build every referral yourself and your caseload is limited to people who can pay out of pocket. Insurance: lower net per session and real admin overhead — but the panels are themselves a referral source, and your practice is available to people who otherwise couldn't see you.
Most sustainable practices land on a deliberate mix. What matters is that it's a decision with the arithmetic done, not a default.
Paneling is a strategy, not a form
Florida specifics — which payers matter, the carve-out trap, Medicare and Medicaid — are in getting on insurance panels in Florida.
Which payers, in what order, matters enormously. Panels differ in reimbursement, in how much of your local population they cover, and in whether they're open to new providers at all. Applying to everything is the common instinct and a bad one.
This is the one to hand over
Credentialing is slow, procedural, unforgiving of small errors, and every week of delay is a week you aren't paid. It also makes you exactly zero percent better as a clinician. We do credentialing, payer paneling, and ongoing billing and claims — for solo clinicians and group practices, nationwide. If you outsource one thing in this entire guide, outsource this one.
Start credentialing →4Filling the caseload Do the break-even arithmetic before the marketing. “I'll charge $150” and “I need 17 sessions a week” are the same fact, and only one of them tells you whether you can go full-time.+
Where clients actually come from, roughly in order of reliability for a new solo practice:
- Insurance panel directories — often the largest single source if you're paneled, and it costs nothing extra
- Professional referral relationships — the ones you started in Phase 0
- Psychology Today and similar — reliable, cheap, everyone is there
- Google Business Profile — free, and consistently underused by therapists
- Your own site — slow, compounds over years, worth starting early precisely because of the lag
The other half of a full caseload is retention. A practice at 20% no-shows and one at 8% are different businesses at identical rates and caseloads. A clear policy, consistently applied, is worth more than another directory listing.
Your time is worth more in the room
Chasing claims, posting payments and reworking denials is a part-time job you didn't apply for — and it's the one area where mistakes cost you revenue directly. We run the billing and the administrative back end so the hours go where they're actually worth something.
Hand off the back office →5When you stop being solo Three genuinely different businesses: raise rates and cut volume, add clinicians and become an employer, or become a qualified supervisor — the most reliable hiring pipeline in this field.+
- Raise rates, reduce volume — the simplest, and available to most people earlier than they think
- Add clinicians — now you're an employer. Contractor vs employee classification is a real legal question with real penalties (see 1099 or W-2: is your clinician really a contractor?), and the fee split determines whether the model works at all
- Become a qualified supervisor — a revenue line and a hiring pipeline at once, since supervisees become associates. See how to become a qualified supervisor in Florida
Practices that stall here usually do so because the owner is still the only person who can do anything — clinician, biller, scheduler, marketer and boss. The first hire that actually creates capacity is almost always administrative, not clinical.
The part where owners get stuck
Going from one clinician to several breaks every system that worked when it was just you — scheduling, billing, credentialing each new hire, vendor contracts, the admin load. Practice scaling and managed operations is what we do, and it's the difference between a group practice and a solo practice with extra stress.
Talk about scaling →The five that cost the most
- Starting credentialing after resigning. Six months of no insurance revenue, entirely avoidable by sequencing.
- Pricing off the rate instead of the net. A $150 session is not $150 of income, and the gap between those numbers is where practices quietly fail.
- Not reading the employment agreement. Non-competes and non-solicits are found after the resignation far more often than before it.
- No runway. Practices don't usually fail because they're bad. They fail because they weren't given enough months to work.
- Doing your own billing to save money. Sometimes right early on. But count the hours honestly — at ten hours a month you're paying yourself a poor wage to do a job you're not trained for, in the one area where errors cost you revenue directly.
This is information, not legal, tax, or financial advice. Entity selection, tax treatment, employment classification, and contract enforceability are specific to your circumstances and jurisdiction — work with an attorney and a CPA who know Florida mental health practice. Florida licensure requirements come from the Board and Chapter 491, F.S.; verify anything here against floridasmentalhealthprofessions.gov before acting on it. Credentialing timelines vary by payer and are estimates, not guarantees.
Sources: Chapter 491, Florida Statutes (2025) · Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling