Alternative credentials include a certificate, diploma, license or membership. When the no-license option is selected, you are required to provide alternative credentials on the form and by fax. You have the option to provide your license number, your supervisors license number, or you can select no license. Submit this information to proceed to the third page, where you enter information about the practice and credentials.Įnter in the years of experience, school and graduation date and licensing information. Optional fields include Credentials, such as MA or PhD, Company Name and Website. Title, name, address and phone number fields are required. ![]() Continue on to the second step and enter in your name and location.
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