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.

Psychologist Information:
Name of National Register Member*
First Last
Name
First Last
Email of National Register Member*
Purpose of Verification*
If other, please specify*
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.
Please send verification to:
Licensing Board*
State/Organization:*
Name of Contact at State/Organization*
First Last
Name of Contact at Licensing Board
First Last
Email of Contact at State/Organization*
Email of Contact at Licensing Board
How would you like the verification sent?*
Can we send verification via email?
- Yes
- No
Address for Hardcopy Mailing*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address for Email Copy*
Special Instructions
Who is submitting this request?*
Are you the Registrant or are you an employer, healthcare organization, etc., requesting to verify provider credentials?
- National Register member
- Employer, healthcare organization, other
Please Provide Member's National Register HSP Credential Registrant ID
To avoid delay in processing your request, please include the member's National Register HSP ID on this form.

202.783.7663

Contact Us

202.783.7663

Contact Us

202.783.7663

Contact Us

Request a Verification

Psychologist Information:

Please send verification to:

Endorsed by the National Register

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