Starting a behavioral health clinic in Texas can be a rewarding endeavor, but it requires careful planning and adherence to regulatory requirements. This guide walks you through each step, from developing a business plan to obtaining the necessary licenses and credentials.
Written by the Circa Behavioral Editorial Team • Reviewed by Compliance & Accreditation (Texas HHSC / TJC / CARF) • Last updated: September 9, 2025
This guide is informational, not legal advice. Confirm requirements with your counsel and regulators.
How to Open a Behavioral Health Clinic in Texas
Opening a behavioral health clinic in Texas takes a clear plan, the right licenses, and programs that meet local needs. Use this step-by-step to move from idea to licensed, operational care. It applies to mental health clinics, chemical dependency treatment facilities, and integrated practices.
Understand Services and Market Needs
Decide what you will offer. Examples include individual and group therapy, psychiatric evaluation, medication management, addiction treatment, crisis services, or specialty tracks for veterans, youth, perinatal clients, or rural communities. Check waitlists and payer mix with the Texas Health & Human Services Commission (HHSC), SAMHSA, and local health assessments.
- Scan HHSC program pages to see funded services and referral pathways.
- Map competitors and underserved areas in Houston, Dallas, Austin, San Antonio, and rural counties.
- Validate reimbursement sources. Include Medicaid, Medicare, commercial plans, and self-pay.
Write a Focused Business Plan
- Define mission, target population, and service lines: OP, IOP, PHP, residential, detox.
- Outline staffing models and ratios, coverage hours, and on-call plans.
- Build financials for startup and operating budgets, payer mix, break-even, and reserves.
- Embed risk management, quality, and compliance from day one.
Need a template? See Startup & Operations and Compliance Services.
Choose an Entity and Register
Select an entity (LLC/PLLC, PC, nonprofit). File with the Texas Secretary of State (SOSDirect) and obtain an EIN.
Know Which Licenses You Need in Texas
Program/facility level (varies by services):
Substance Use Disorder (SUD) treatment facilities must license as a Chemical Dependency Treatment Facility (CDTF) with HHSC. Review the CDTF licensing page and the Form 3207 application.
Mental health outpatient services should confirm HHSC requirements for the setting and scope, especially if adding residential or specialty services.
Optional accreditation—often required by payers—includes The Joint Commission or CARF Behavioral Health.
Professional licensure (people who deliver care):
The Texas Behavioral Health Executive Council (BHEC) regulates LMFTs, LPCs, LCSWs, and Psychologists. Verify scope and apply via BHEC, review how to apply, and verify licenses as part of hiring.
Psychiatrists and other physicians are licensed via the Texas Medical Board.
Texas group home licensing requirements
Depends on the model you operate. If you provide personal care to four or more unrelated adults, you typically need an Assisted Living Facility (ALF) license from Texas Health and Human Services (HHSC). That process starts with pre-survey training and an HHSC application. Some “boarding homes” are not state licensed but must be permitted by the city or county under Health & Safety Code Chapter 260, and many localities adopt HHSC’s Boarding Home Model Standards. Homes serving people with intellectual disabilities may fall under ICF/IID rules and may require a Medicaid bed allocation before licensure. If you plan to deliver residential substance use treatment, you must hold a Chemical Dependency Treatment Facility license and comply with 25 TAC Chapter 448. Need help mapping the right path and getting audit-ready policies and training? Our Compliance Services team can set up the checklist, timelines, and staff education you need.
Enroll with Payers
Texas Medicaid: Enroll via TMHP’s Provider Enrollment and Management System (PEMS). Start here: PEMS application.
Medicare: Enroll through PECOS. Use the PECOS login or follow CMS guidance to become a Medicare provider.
Commercial plans: Contract based on service lines and accreditation status.
Build Your Team
Hire a Medical Director if offering medication management, SUD detox, or MAT.
Staff with LPCs, LCSWs, LMFTs, and Psychologists (regulated by BHEC), plus RNs/LVNs, case managers, care coordinators, and peer support specialists.
Add admissions, billing and revenue cycle, and compliance/quality roles to stay audit-ready.
Evidence-Based Care and Accreditation
Match services to evidence—examples include CBT, MI, DBT, contingency management, and MAT.
Use standardized outcomes (e.g., PHQ-9, GAD-7, Columbia) and ASAM Criteria to level SUD care appropriately.
Consider accreditation by The Joint Commission or CARF to strengthen payer access and credibility.
Need prep? See Licensing & Accreditation Support.
FAQs: Opening a Behavioral Health Clinic in Texas
Do I need a license to open a treatment facility?
If you operate a chemical dependency treatment facility, you must apply through HHSC for a CDTF license. Confirm HHSC requirements for your specific model.
How do I enroll with Texas Medicaid?
Use TMHP’s PEMS portal to enroll and manage your Medicaid participation.
What about Medicare?
Enroll via PECOS online. Some clinic types and professionals enroll individually and reassign benefits to the group.
Which licenses cover therapists?
LPCs, LMFTs, LCSWs, and Psychologists are regulated by BHEC. Verify license status and scope on the BHEC site.
What privacy rules apply?
HIPAA applies to covered entities and business associates. Programs offering SUD services must also comply with 42 CFR Part 2 (updated rule; general compliance date February 16, 2026).
