Recounting Workforce: The Impact of Multi-licensure on Behavioral Health Provider Estimates

Accurate behavioral health workforce estimates are essential for workforce planning, shortage designation, and policy development. However, workforce reports often rely on license counts rather than unique providers, which can inflate workforce estimates when clinicians hold multiple licenses. This study examined the prevalence and geographic distribution of multi-licensure among Nevada behavioral health providers and assessed its impact on workforce estimates. A cross-sectional analysis was conducted using administrative licensure data from Nevada licensing boards for Marriage and Family Therapists (MFTs), Clinical Professional Counselors (CPCs), Alcohol and Drug Counselors (ADCs), and Problem Gambling Counselors (PGCs). Active licenses through December 2025 were linked at the individual level to identify unique providers and patterns of multi-licensure. Descriptive statistics summarized licensure combinations, while chi-square tests and logistic regression examined geographic differences by county type. Among 3259 unique providers, 382 (11.7%) held two or more licenses. The most common multi-licensure combinations were MFT/ADC (n = 189) and CPC/ADC (n = 143). Providers collectively held 3660 licenses, meaning license counts alone would overestimate the workforce by approximately 12.3%. In this Nevada methodological demonstration, summing records across four overlapping credentials produced a higher estimate than linking records at the individual level. States using licensing data for workforce surveillance should deduplicate records across boards and distinguish the number of credentials from the number and clinical capacity of unique practitioners. Multi-state replication across a broader set of behavioral health professions is needed.