Request a Verification

Submit this form to process a verification request for National Register members with an active HSP Credential. For member email address, please use the email address the member has on file with the National Register. This will help us process your request in a timely manner. The National Register of Health Service Psychologists HSP Credential is separate from NPI. Learn more about the National Register HSP credential.

Verification Request:
Who is submitting this request?*
Are you the National Register member or are you an employer, healthcare organization, etc., requesting to verify provider credentials?
- I am the National Register member (I currently hold an active National Register HSP Credential)
- I am an employer, healthcare organization, other
Employers and healthcare organizations: Please create an account (simply go to https://my.nationalregister.org and create an account with your organization email address) as a "credentials verification specialist" to verify a provider’s credentials. To verify for Social Security Administration, you can complete this form and add provider details to the “Special Instructions” box on the form below.
Purpose of Verification*
If other, please specify*
Reminder: Please create an account (simply go to https://my.nationalregister.org and create an account with your organization email address) as a "credentials verification specialist" to verify a provider’s credentials. Once you have created your account, you will receive an email with more information on how to verify provider credentials.
Please note: If the state for which you are requesting a verification letter is not a participating jurisdiction in our licensure mobility program, or is currently noted as "in process," we cannot guarantee the licensing board will accept our verification letter.
Details:
Licensing Board*
Organization:*
Name of Contact at Organization*
First Last
Name of Contact at Licensing Board
First Last
Email of Contact at Organization*
Email of Contact at Licensing Board
Special Instructions (if applicable)
REQUIRED: Your Information (Psychologist/National Register Member):
Name of National Register Member*
First Last
Email of National Register Member*

Should match your primary email address on file with National Register
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Email Address for Email Copy*
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How would you like the verification sent?*
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Name
First Last
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Address for Hardcopy Mailing*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

202.783.7663

Contact Us

202.783.7663

Contact Us

202.783.7663

Contact Us

Request a Verification

Verification Request:

Details:

REQUIRED: Your Information (Psychologist/National Register Member):

Endorsed by the National Register

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