Starting a private practice is simpler than most therapists think — and harder in the ways most therapists don't expect.
The clinical side of private practice isn't new to you. You already know how to evaluate, treat, document, and coordinate care. What's new is the business side — and that's the part that either makes the transition smooth or creates the six-month grind most new independent therapists describe.
This guide covers what you actually need to get started, in the order you need it. Not everything. Not a list of optional nice-to-haves. The things that block you from seeing your first patient if they're missing.
Step 1: Decide on your practice structure
The two most common structures for solo pediatric therapists are sole proprietorship and single-member LLC. Most therapists start as sole proprietors — no filing, no fees, no separate entity. Your practice income flows directly to your personal tax return on Schedule C.
An LLC provides a cleaner separation between personal and business finances and some liability protection, though in healthcare the value of that protection is somewhat limited since malpractice claims go to your insurance regardless of business structure. An LLC typically costs $50-500 to form depending on your state, plus annual filing fees.
Before you start billing insurance, you need three things regardless of structure: a business name (can be your own name if you prefer), a business bank account (keep business and personal finances completely separate from day one — this makes taxes dramatically simpler), and a free EIN from the IRS (takes 10 minutes at irs.gov and is required for most insurance credentialing applications).
Step 2: Get your NPI
If you don't already have a National Provider Identifier, get one. It's free through the NPPES website and required for any insurance billing. If you have an NPI from a previous employer, it's yours — you don't need a new one, but confirm your taxonomy codes accurately reflect the type of practice you're starting. For pediatric-specific practice, make sure your taxonomy code reflects your discipline and specialty. Incorrect taxonomy codes are a common credentialing delay.
Step 3: Professional liability insurance — before your first session
This is the step that's most often skipped by therapists who are eager to start seeing patients. If you've been covered through an employer, that coverage ends when you leave. You need your own professional liability (malpractice) policy in place before you see a single patient in an independent capacity.
Individual malpractice coverage for pediatric therapists typically runs $500–$900/year depending on your discipline, state, and coverage limits. HPSO (Healthcare Providers Service Organization) and CPH & Associates are the most commonly used insurers for independent therapists. Most policies can be purchased and activated within 24-48 hours.
You'll need your malpractice certificate for credentialing applications, so get this before you apply to any payers.
Step 4: Insurance credentialing — start earlier than you think
Insurance credentialing is the step that takes longest and surprises most therapists. The process of becoming in-network with an insurance company takes 60 to 120 days per payer — and you need to submit to each one separately. There is no way to speed this up significantly. Insurance companies have internal review processes that run on their own timeline.
The practical implication: start credentialing before you leave your current job if at all possible. Every week you wait after leaving is a week of potential income you can't collect from insured patients.
Which payers to apply to first depends on your market. In Massachusetts, prioritize Blue Cross Blue Shield, Harvard Pilgrim, and Tufts. In Texas, start with BCBS of Texas and Baylor Scott & White. In New Hampshire, Anthem BCBS NH and Harvard Pilgrim. Don't apply to ten payers simultaneously if you can't manage ten parallel application processes — start with the top two or three for your market and add more once you're established.
Before applying to any payer, set up your CAQH ProView profile. CAQH is a centralized database that most major insurers use to pull provider information during credentialing. Completing your CAQH profile before you start applications saves you from entering the same information ten times. CAQH attestations expire every 120 days — add a calendar reminder to re-attest.
Step 5: HIPAA-compliant documentation — required from day one
Any records containing patient information — session notes, evaluations, assessment results, intake forms — must be stored in a HIPAA-compliant system. Standard Google Drive, Dropbox, and regular email are not HIPAA compliant. A signed Business Associate Agreement (BAA) with your software provider, encryption, and access controls are required.
A purpose-built EMR handles this automatically. SimplePractice, TheraNest, and WebPT are the most common options for solo pediatric therapists, running $30–$100/month depending on tier and features. See our comparison of EMR options for pediatric therapists for a breakdown of each.
If you're joining Coral Care, documentation is handled through CoralPro — you don't need a separate EMR.
Step 6: Find your first patients
Your first referrals will most likely come from existing relationships, not cold outreach. The most productive early referral sources:
- Pediatricians you've worked with in your current role — a personal introduction email or a one-page referral card is enough to get started.
- Families from your current practice who need to continue services — depending on your employment agreement, transitioning families requires careful attention to non-solicitation clauses.
- EI programs in your area — families aging out at three need a provider. Coordinators are always looking for therapists they can trust with their families.
- Local parent Facebook groups and neighborhood community apps — a brief, genuine introduction post often generates immediate inquiries in areas with high demand.
You don't need a professional website to see your first patient. You need a way for a pediatrician to refer to you — a simple one-page document with your name, disciplines, insurance plans accepted, and contact information is enough to start.
What you can legitimately skip at first
Many things get listed as necessities for independent practice that are actually conveniences: a professional website, a logo, social media accounts, a PLLC, a clinical office, a billing service, a virtual assistant. None of these are required to see your first patient.
Start lean. Build infrastructure as your caseload and revenue grow. The therapists who struggle in early independent practice are almost always those who front-loaded infrastructure investment before they had the caseload to justify it.
The faster path: Coral Care
The steps above describe building a fully independent practice from scratch. It works, and many therapists do it successfully. But it takes time — typically 3-6 months before a solo therapist reaches a stable caseload.
Coral Care is designed to compress this timeline. When you join our platform, credentialing is already in place, billing infrastructure is already running, and patient matching brings families to you rather than requiring you to generate your own referrals. Most Coral Care providers are seeing patients within 2-4 weeks of joining. Learn how Coral Care's onboarding works.
Frequently Asked Questions
Do I need a business license?
Requirements vary by state. Most states don't require a separate business license for a sole-proprietorship therapy practice beyond your clinical license. Check your specific state's requirements — your state's business registration website is the most reliable source.
How many patients do I need to make private practice financially viable?
At typical in-network rates in most markets, 15-20 patients per week generates a full-time income. The exact number depends on your rates, payer mix, and geography.
Can I do in-home therapy without a clinical office?
Yes — and for in-home practice, your home serves as your administrative base. You need HIPAA-compliant documentation storage and a professional space for scheduling and billing work. A clinical office is not required.
