Photo Tool
File Types Allowed: GIF,JPG,JPEG,BMP,PN

Photo Upload Instructions

P-LPC License No. P-9995
LPC License No.: 0

Last Name:  Atest
First Name:  Bill
Middle or MI:  Henry
Title:  Mr.
Suffix:  Jr., LPC-S

SSN: XXX-XX-8888
DOB:  1946-04-21

P-LPC Evaluation Form

(A) All LPC-Supervisors are required to complete, sign, and submit an annual P-LPC Evaluation Form even if you choose NOT to renew your LPC-S designation.

Prepare PL-LPC Evaluations

It has been more than 1 year since your last renewal: You must submit a new application for licensure, complete with all supporting documentation. To submit a new application, you must contact the Board office for permission to begin the process.

 If you have question, please contact the LPC Board to discuss.
Phone: (601) 359-1010

General Registration

————————————————————

Published Address (Public):  Home  – Business – Do Not Publish

Published Phone Number:     Home  – Business – Do Not Publish

Board Correspondence:          Home  – Business

List email on Board website:      Yes – No

Release published address and email to State and National organizations:      Yes – No

Address

————————————————————

Home Address Business Address
Item 1 entry Item 6 entry
Item 2 entry Item 7 entry
Item 3 entry Item 8 entry
Item 4 entry Item 9 entry
Item 5 entry Item 10 entry

Registration Information

————————————————————

Home Address Business Address
Item 1 entry Item 6 entry
Item 2 entry Item 7 entry
Item 3 entry Item 8 entry
Item 4 entry Item 9 entry
Item 5 entry Item 10 entry

Supervisor for:

————————————————————

Education Information

————————————————————

CE Hours Required: 24
CEH Current   View/Update – Taken: 0 hrs  – (0 hrs. Ethics/Legal, 0 hrs. Regular, 0 hrs. Supervisory, 0 hrs. Telemental )
CEH History – View

The information below is informational only and cannot be updated from this tab. It is populated from the application for licensure.

NATIONAL COUNSELOR EXAMINATION (NCE) TAKEN: Yes No If Yes, Date Taken: 2009-09-01
Indicate Pass/Fail: Pass Fail If Pass, Score: 101/96 (your score / minimum score)

NATIONAL CLINICAL MENTAL HEALTH COUNSELOR EXAM (NCMHCE) TAKEN: Yes No
If Yes, Date Taken: Indicate Pass/Fail: Pass Fail If Pass, Score: 103/90 124/115

Have you requested passing scores be forwarded to the Board Yes No

DEGREE: Ph.D. Specialist Master’s Other
Date Awarded: 2010-06-30
Program/Major: People,
Name of Institution: University of MS
Street Address: 97 Some St
City/State/Zip: Townville / MS / 39888

DEGREE: Ph.D. Specialist Master’s Other
Date Awarded:
Program/Major: ,,,,
Name of Institution:
Street Address:
City/State/Zip: / MS /

Application Information

———————————————————————————

Document Tracking

Document Tracking
————————————-

(Date Received in Board Office)
Background Check:
Required By:
Received On:

NBCC Exam:
NCE Exam:
NCMHCE Exam:
JP Exam Passed On:

 2022-09-30
2022-05-18

2014-09-01
2018-09-03
2018-09-12

Transcripts:
School Date
school1 2014-09-01
school2 2014-09-03
school3 2014-09-05
Verification of licensure in other jurisdiction: Not Received

Verification Notes:

 Out of State License Documents

State Date

Application Review Information

Application Review Information

——————————————————————

Activity
 Denied On 2019-04-16. Click to see in popup window
 Denied On 2019-04-16. Click to see in popup window

Application was started on 9/4/2014

Application was started on 9/4/2014

—————————————————-

P-LPC Application Submit Date:
P-LPC Application Expiration Date:
P-LPC Application Last Renewal Date:

You are required to report a minimum
Log Hours of   Total: 3500   Direct Services/Face to Face: 1167   Supervision: 100

Application Status

Application Status

—————————————————-

Application Start Date: 9/4/2014
Application Submit Date: 2019-04-01

I hereby make application for Licensed Professional Counselor pursuant with the laws of the State of Mississippi and the Rules and Regulations for The Mississippi State Board of Examiners for Licensed Professional Counselors.

(check one)

UNIVERSAL LICENSURE: If you currently hold a LPC license in another state with at least one (1) year of professional work experience as a counselor since the date of initial licensure, that licensure was maintained continuously during that year and that no substantiated complaints or disciplinary action(s) have ever been taken against the licensee. Submit a Curriculum Vitae (C.V.) and Verification of Licensure in Other Jurisdiction along with certified copies of the contents of licensure file sent directly to the Board’s office.
Curriculum Vitae (C.V.)    Residency Proof    Affidavit

Complaints

———————————-

No Complaints for this person.

 

Print Forms

—————————————

 

 

 

 

 

 

Forms that require a fee are also listed under the Online Payments Tab.

Online Payments

——————————————–

 

Failure to Notify Change of Address Fee
File Transfer Fee
License Verification Fee
Name Change Fee (New Wall Certificate)
Per Page Copy Fee
Replacement Renewal Card Fee
Replacement Wall Certificate
Request for Determination
LPC-S Application Fee
   

 

Note: Do not use any of the options
below unless instructed to do so by the Board.

 
NOTE: These are NOT for license renewals. The renewal button will be shown in the upper right part of your screen once you have completed all the pre-renewal steps. Renewal Instructions
Initial License Fee