Arkansas Board of Examiners in Counseling/Marriage & Family Therapy

SPECIALIZATION LICENSE APPLICATION

Print Name: _________________________________________________________________________

Address: ____________________________________________________________________________
City: ______________________________ State: _____ Zip Code: ___________________________
Phone: ____________________________ Email: __________________________________________

Please send $50 Application fee for each Specialization requested.

School _______________ Hypnotherapy _________
Career _______________ Pastoral Counseling __________
Rehabilitation _________ Supervision-LAC ___________
Appraisal _____________ Supervision-LAMFT __________
Sexual Abuse (ATSA) _____ Supervision Dual LAC/LAMFT ________
Drug & Alcohol _______ Play Therapy __________
Addictions ___________ Dance Therapy __________
Art Therapy __________ Neurofeedback __________
Mediation ___________ Technology-Assisted Counseling __________
Coaching ____________ Technology-Assisted Supervision __________
Recreation ___________ Behavior Analyst/Therapeutic Specialist __________
Music Therapy ________ Therapeutic Humor __________
EMDR ______________ Eating Disorders _____________
Animal Assist.Therapy _____ Trauma _________

Please attach training, academic credentials and fee to support each request for Board approval. You must
document meeting National Standards for each Specialization requested.
Be sure to include a new Statement of Intent indicating your Specialization.

Signature: _________________________________________ Date: _________________________

UPDATED 10-3-2017 1
 SPECIALIZATION INFORMATION

Appraisal and Supervision Hypnotherapy

(Request application materials from) (Request application materials from)

Arkansas Board of Examiners in Counseling National Board for Certified Clinical Hypnotherapists (NBCCH)
101 E. Capitol, Suite 202 8750 Georgia Ave., Suite 142-E
Little Rock, AR 72201 Silver Spring, Maryland 20910
Phone: (501) 683-5800 Phone: (301) 608-0123 or (800) 449-8144

Rehabilitation Drug & Alcohol

(Request application materials from) (Request application materials from)
Commission on Rehabilitation Counselor Certification (CRCC) Arkansas Substance Abuse Certification Board (ASACB)
1835 Rohlwing Rd., Suite E UALR-Midsouth
Rolling Meadows, Illinois 60008 2801 South University Ave.
Phone: (708) 394-2104 Little Rock, AR 72204-1099
Phone: (501) 569-3073
Pastoral
(Request application materials from) Play Therapy
American Association of Pastoral Counselors (AAPC) (Request application materials from)
9504 A Lee Highway Association for Play Therapy
Fairfax, Virginia 22031-2303 2050 N. Winery Ave., #101
Phone: (703) 385-6967 Fresno, CA 93703
Phone: (559) 252-2278
Association for Clinical Pastoral Education, Inc. info@a4pt.org
1549 Claremont Road, Suite, 103
Decatur, GA 30033 Technology -assisted Specialization
Email: acpe@acpe.edu Comply with Rule Section 3.5, (9), (A-F
www.acpe.edu page 12, and Section XII pages 46 through 49

Art Therapy Credentials Board Dance Therapy

Phone: (877) 213-2822 *** www.atcb.org (Request application materials from)
American Dance Therapy Association (ADTA)
2000 Century Plaza, Suite 108
10632 Little Patuxent Parkway
School, Addictions, Clinical Mental Health/Psychotherapist Columbia, Maryland 21044
Clinical
(Request Mental Health
application Counselor/Psychotherapist,
materials from)
National Board for Certified Counselors (NBCC) Mediation
3 Terrace Way Arkansas Alternative Dispute Resolution Commission
\
Greensboro, NC 27403-3660 (Request application materials from)
Phone: (336) 547-0607 Arkansas Alternative Dispute Resolution Commission
www.nbcc.org 625 Marshall Street
Little Rock, AR 72201
Recreation Therapeutic Counselor Phone: (501)682-9400
(Request application materials from NCTRC
National Council for Therapeutic Recreation Certification)
Behavioral Analyst
7 Elmwood Drive Metro Building -- Suite 102
New City, New York 10956 1705 Metropolitan Blvd
Phone: (845) 639-1439 Tallahasse, FL 32308-3796
www.NCTRC.org www.bacb.com

App

UPDATED 10-3-2017 2
 Applied Therapeutic Humor

(Request information and application materials from)

Association for Applied and Therapeutic Humor
220 East State Street FL. G
Rockford, IL 61104
888-747-AATH (2284) Toll Free
815-397-6052
Email: info@aath.org

Coaching

Must adhere to the Standards promulgated by NBCC

as a Board Certified Coach

UPDATED 10-3-2017 3