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How to Become an LMHC in Washington State

Washington’s Department of Health issues the LMHC to counselors who pass one of two NBCC exams: the NCE or the National Clinical Mental Health Counseling Examination (NCMHCE). Applicants also complete 3,000 hours of supervised postgraduate counseling and hold a master’s or doctorate in mental health counseling or a related behavioral science. Graduates of CACREP-accredited programs receive automatic credit toward the experience requirement.

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Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions — this is exam-preparation material, not medical advice. Last reviewed October 2026.

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Which exams does Washington accept for the LMHC?
Either the National Counselor Exam (NCE) or the National Clinical Mental Health Counselor Exam (NCMHCE), both from NBCC. The Department of Health states that both are accepted for licensure in Washington State.
How much supervised experience does Washington require?
A minimum of 36 months of full-time counseling or 3,000 hours of postgraduate mental health counseling under an approved supervisor. At least 1,200 of those hours must be direct counseling with individuals, couples, groups or families, and at least 100 hours must be immediate supervision.
Does a CACREP degree help in Washington?
Yes. Applicants who completed a master’s or doctorate in a CACREP-accredited counseling program receive automatic credit toward the supervised postgraduate experience requirement, applied once an official transcript confirms they finished the program.
What degree does Washington require?
A master’s or doctoral degree in mental health counseling, or a behavioral science master’s or doctorate in a field related to mental health counseling. The core of study must cover seven content areas from the state’s list, five of them from its first eight areas.
What does the licence cost in Washington, and how do I apply?
The initial licence is $191, which includes a $16 fee for access to the University of Washington’s HEALWA health resources site. Renewal is $141 a year, due on or before your birthday. You apply online through the Department of Health’s HELMS system after creating a Secure Access Washington account.

Test yourself: 3 NCMHCE practice questions

Tap an answer for instant feedback and the full rationale. The app has 4,000+, timed and scored.

Question 1

Daniela moves quickly between the ER visits, her fear of another attack, and her worry that the doctors missed a heart problem. What is the most useful way to assess her presenting problem and level of distress at this intake?

▸ Why D is the answer

Tracing one concrete attack from its first sensation through her thoughts, her actions, and its passing gathers the phenomenology, the triggers, the catastrophic thinking, the behavior, and the onset all at once. It also shows immediately whether her symptoms follow the discrete-attack-plus-anticipatory-worry pattern of panic, which is exactly what you need to see next.

Question 2

Daniela's episodes involve a pounding heart, chest tightness, and shortness of breath, and she remains half-convinced a cardiac problem was missed. Before settling on a psychological formulation, how do you best handle the medical picture?

▸ Why B is the answer

Panic-attack symptoms overlap real medical problems, cardiac arrhythmia, thyroid disease, low blood sugar, and stimulant or caffeine effects, and the diagnosis requires that the attacks not be due to a substance or another medical condition. Confirming that the workup actually ruled those out, and screening her high caffeine and energy-drink intake, is the right diligence, and it is collaborative rather than dismissive.

Question 3

Weighing everything Daniela has described, which provisional diagnosis is best supported, and on what grounds?

▸ Why C is the answer

The picture fits panic disorder cleanly. The attacks are recurrent, unexpected, and crescendo within minutes, and for over a month she has persistently feared the next one and reshaped her behavior around it, taking surface streets, sitting near exits, and offloading the shopping. Onset was three months ago, and the medical and caffeine rule-out is underway. That combination, unexpected attacks plus a month or more of anticipatory worry and avoidance, is the definition.

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