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North Dakota Mental Health Outpatient Licensing

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A. Ant, CADC-II

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Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.

When North Dakota’s Century Code lists the behavioral health duties of the Department of Health and Human Services, the only licensing job it names is “establishing quality assurance standards for the licensure of substance use disorder program services and facilities” (N.D.C.C. 50-06-01.4, the section that lays out the department’s structure). Outpatient mental health care gets no matching line. In practice that leaves a private counseling or psychiatric practice with no facility license to apply for, by our reading, while two narrower organizational routes do exist: HHS certification for a certified community behavioral health clinic, and the license that covers the state’s own behavioral health clinics.

Where the Statute Stops

This section is our interpretation of the statutes and HHS pages it cites. HHS has not said it in those words.

We looked for an outpatient mental health license in the places one would sit. The facility types on HHS’s public health licensing page include ambulatory surgical centers, basic care, home health, hospice, hospitals and rural health clinics, among others, while the behavioral health link on the department’s licensing hub leads to the substance use program page. On that page, the words “mental health” turn up only inside the name of the federal Substance Abuse and Mental Health Services Administration. Article 75-05 of the Administrative Code, Human Service Center Licensure Standards, deals with the state-run centers. The commitment act, N.D.C.C. 25-03.1, recognizes private treatment facilities only if they are licensed as hospitals or SUD programs.

Put together, those sources leave no state license that a private outpatient mental health program could apply for, as far as we can tell. The regulation an office practice actually feels comes through its clinicians’ individual licenses, its business registration and, if it ever adds addiction treatment, the Behavioral Health Division (BHD). Because absence is hard to prove, a short written question to HHS before opening is cheap insurance.

Outpatient Mental Health Models and What Each Needs

Rows restate the statute or rule named, except the first, which is our reading.

ModelState approvalGoverning textWorth knowing
Private therapy or psychiatric practiceNo facility license foundClinicians’ own board licensesConfirm with HHS before opening
Certified community behavioral health clinic (CCBHC)HHS certificationN.D.C.C. 50-06-41.4Certification rules must include a need assessment for the proposed site
State-operated behavioral health clinicHHS license or certificationN.D.C.C. 50-06-05.2Applies to the former regional human service centers, and HHS may license on accreditation
Practice that adds SUD outpatient or IOP servicesBHD program licenseN.D.C.C. 50-31, NDAC 75-09.1-06 and -07SFN 971 application, $150 nonrefundable fee

The CCBHC row is the newest. SB 2113, signed May 2, 2025, wrote it into the code, and N.D.C.C. 50-06-41.4 now reads “To operate in this state, a certified community behavioral health clinic must be certified by the department.” The need assessment is the part that surprises people, since North Dakota has otherwise repealed its certificate of need law. A clinic that never calls itself a CCBHC is outside this section. A separate funding relationship with HHS sits outside licensing too, and we do not handle it.

Adding Substance Use Services to a Therapy Practice

This is where a mental health practice most often crosses into licensing. N.D.C.C. 50-31-02 says a person “may not establish, conduct, or maintain in this state a substance use disorder treatment program” without a license. Nothing in chapter 50-31 carves out exemptions, and its definitions section never says what counts as a substance use disorder treatment program, so we cannot point you to a written carve-out for a therapist who sees a few clients with addiction issues. BHD describes itself as licensing “all substance abuse treatment programs in North Dakota,” and the same page asks a counselor who is “applying as a private practice” for confirmation of registration from the counselor board. That counselor also needs board registration to practice privately at all, because N.D.C.C. 43-45-05.3 says a person “may not engage in the private practice of addiction counseling” without it.

Our reading is that a practice planning a defined addiction track, such as Level I outpatient or Level II.1 intensive outpatient, should expect a BHD license. Put the question to BHD (dhsbhd@nd.gov, 701-328-8920) before the service is advertised, and see North Dakota Drug and Alcohol Outpatient Treatment Licensing for the application itself. One 2025 change helps blended practices. SB 2079 made licensed addiction counselors “tier 2b” mental health professionals, so an LAC on a mixed team now holds a recognized mental health professional tier as well.

Ketamine and Spravato in a North Dakota Outpatient Practice

No North Dakota statute or rule addresses ketamine in an office practice. The analysis below is our reading of the nursing board guidance, Board of Nursing rules, the PDMP statute and the federal sources cited.

With no facility license in the picture, ketamine or Spravato in an outpatient mental health office is part of the prescriber’s own practice. We also found no North Dakota license category for an office ketamine clinic. That moves the real compliance work onto the drug and the people handling it.

Registration comes first. Ketamine is listed in Schedule III (21 CFR 1308.13(c)(7)), and under 21 CFR 1301.12 every principal place of professional practice where controlled substances are dispensed carries its own DEA registration. A practice that stocks ketamine at two offices plans for two registrations. No primary source we found says whether a North Dakota practitioner needs a state controlled substance registration in addition to the DEA one, so ask the State Board of Pharmacy before ordering stock.

Nurse practitioners are a real option here. Under NDAC 54-05-03.1-09 an APRN gets prescriptive authority through a separate Board of Nursing authorization, with a $75 fee and 30 contact hours of pharmacotherapy education, and the rule text we read sets no collaboration or supervision requirement. Our reading is that an authorized APRN prescribes on their own license. That APRN must check the PDMP for any new patient who needs a controlled substance, every six months while treatment with a controlled substance continues, and whenever misuse is suspected. The PDMP itself belongs to the State Board of Pharmacy under chapter 19-03.5, and that chapter excludes a practitioner who “administers a controlled substance to a patient” from the definition of a dispenser. Doses given in the office therefore look outside dispenser reporting to us, though the Board of Pharmacy is the one to confirm it.

Who gives the dose matters more in North Dakota than in many states. The Board of Nursing’s January 2026 sedation and analgesia guidance puts anesthetic agents such as ketamine “for analgesia/sedation” outside the scope of RNs and non-CRNA APRNs except in listed situations, and leaves LPNs out entirely. It says nothing direct about psychiatric dosing. An office planning IV ketamine should get the Board’s view before assigning infusions to nursing staff. For Spravato, the boxed warning on the FDA label says “patients must be monitored for at least 2 hours at each treatment session,” and the drug “is available only through a restricted program under a REMS called the SPRAVATO REMS.”

Ownership is the open question. North Dakota has no statute, rule or appellate medical decision on corporate practice of medicine that we could find, only a 1990 Attorney General letter, not binding, that described the state’s public policy as barring a non-professional corporation from employing physicians and left any prosecution to the judgment of each state’s attorney. Our position is that the law is unsettled. The ketamine section of North Dakota Drug and Alcohol Outpatient Treatment Licensing walks through the ownership setups a stand-alone clinic tends to use, and a North Dakota health care attorney should look at any investor-owned model.

Staffing a North Dakota Outpatient Practice

Pay runs higher here than nationally. BLS puts North Dakota’s substance abuse, behavioral disorder and mental health counselors at a $68,630 median, a 25th percentile of $55,450 and a 75th of $77,320 (BLS OEWS, May 2025). The country-wide median from that release is $59,350. Two clinicians at the state median add up to about $137,260 in yearly base pay by our math, before benefits and before a supervising clinical lead. That gap above the national figure is manageable for a practice that hires with its supervision structure in mind. If the practice runs an addiction track, it can hire people still logging the 960 clinical training hours the LAC demands, since the counselor board allows a year of registered trainee status for that work. With a licensed counselor supervising them at trainee wages, the addiction side of payroll commonly comes in 40 to 60 percent lower than it would with licensed counselors only. Social work, counseling and psychology each have their own board and supervised tiers, which fall outside this guide. If the practice adds a medication service with nursing, one RN directing LPNs on tasks within LPN scope costs less than an all-RN staff. The service mix you settle on decides the final roster.

What Trips Up North Dakota Outpatient Practices

Most of the trouble starts with an addiction track added informally, a group or two at first, without anyone asking BHD whether that is now a substance use disorder treatment program. The other recurring problem is ketamine staffing, where an office assumes its RNs can run infusions and only later reads the Board of Nursing’s sedation guidance.

Frequently Asked Questions

Is there a North Dakota facility license for a private therapy or psychiatry practice?

Not that we could find. N.D.C.C. 50-06-01.4 names licensure standards for substance use disorder programs only, HHS’s public health licensing list has no mental health clinic category, and NDAC Article 75-05 covers state-run human service centers. The clinicians’ individual licenses carry the regulation. That is our reading, so put the question to HHS in writing before opening.

What is CCBHC certification in North Dakota?

N.D.C.C. 50-06-41.4, created by SB 2113 (signed May 2, 2025), requires a certified community behavioral health clinic to be certified by HHS before it operates. The statute tells HHS to include an assessment of need in the proposed location in its certification rules. A practice that does not operate as a CCBHC is not covered.

When does a North Dakota therapy practice need a BHD license?

When it operates a substance use disorder treatment program, which N.D.C.C. 50-31-02 bars without a license. The chapter has no exemption section, so a practice planning a defined addiction service such as outpatient or intensive outpatient should expect to file SFN 971 with BHD and pay the $150 fee. Ask BHD at dhsbhd@nd.gov to confirm your model.

Thinking about adding an addiction track or a ketamine service to a North Dakota practice? Start the conversation here.

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