Question
We are considering becoming American expats and moving to Spain, potentially on a Spanish Digital Nomad Visa. It’s my understanding that as long as I maintain my license as a mental health therapist, I can do mental health sessions via telehealth with my clients in the United States. I am wondering if anyone on this page is a mental health therapist who is doing telehealth from Spainor if anyone there is doing therapy in Expat communities in Spain.
Answers
These are the answers from Spainguru’s Facebook group members:
“There are two Facebook groups that I’m finding very helpful for this. The Traveling Therapist and Spain Digital Nomad Visa. Lots of useful info there. I’m doing research now. So far i have learned that you need an LLC, can’t be a sole proprietor. It has to be a company.
Even better if you work for a practice that hired you and that they are OK with you working from Spain. Keep in mind you will be paying Spain taxes on all your global income if you stay in Spain more than 6 months. Feel free to pm me to compare notes.”
“Be sure to move from a state that doesn’t have income tax, if you have your own business. Otherwise, you’ll be liable to pay thousands in income taxes every year.”
“Alternatively, you can live in a state that allows you to credit your tax paid to Spain (via the Foreign Income Tax Credit) against your state tax liability. I file taxes in Arizona, and was able to zero-out my state income tax obligations for the years I was working. Check with your state’s tax agency to confirm whether or not the FITC is applicable.”
“Connecticut seems to allow the use of the FTC unless it’s a very recent change since we filed this year.”
“if you’re not living in a certain state and don’t plan To return to that state then you don’t have to pay income tax to that state no matter if you lived there previously or not”
“??? Where did you get this info, I’m curious. If we move from our current state, then we definitely are liable to pay income taxes. This is why we plan to move to a state with no income tax, short term, before we make the move. Or, there’s also services that can help you obtain an address from a state with no income tax, without ever living in that state.”
“What state are you moving from? And why would you pay taxes to a state that you don’t live in anymore? I lived in California, still use mailing addresses in California but don’t pay taxes in California. They sent me a notice saying I hadn’t filed taxes so I told them I don’t live there and haven’t lived there and don’t plan to return there and that was good enough for them and me. They also noted that my address is a mail center and not a house”
“Check out: The Traveling Therapist®, Location Independent Therapists Lots of helpful information in those groups for exactly this!”
I have a telehealth practice in the United States, but I think that is threatened now by the current government shut down and what could follow from that regarding insurance in the United States. Things are falling apart here, and we would desperately like to leave, but I think we could end up living in another country and then having to leave again. if we were to stop working, we would have to depend on Social Security.
I don’t think that is going to be available much longer in this country and in the next decade, Social Security payments will be reduced. That’s why I want to continue working as long as I can. We have been very lucky to grow up and live our lives in the United States, but things are falling apart here, rapidly. I don’t have hope that things can change. Greed is too strong in this country. We do not have a lot of savings or giant 401(k)’s to live off of in another country. We just need to get real and stay here in the United States, and accept the fact that we will be living in a totalitarian state for the rest of our lives.”
“don’t give up! Join The Traveling Therapist group. The founder if this group figured out how to see insurance patients legally from anywhere and is coaching therapists on this topic. I would reach out to her.”
“Start taking self-pay patients in the USA at affordable prices. I know plenty of people needing a reliable therapist but can’t spend hundreds of dollars on therapy appointments. Yea you would probably make less than you would in a practice or by taking insurance but you could still be very lucrative by providing a more affordable option to people who really need mental health therapy.”
“There is definitely somebody because I messaged with her. I also called my insurance company as I read to make sure that your insurance allows you to do this from out of the country. I am in LCSW and I have prefer a insurance and they said it only mattered where the person was not where I was. The reason I called them is because I read that some policies don’t allow you to be out of the country”
“Join the digital nomad visa group, tons of useful information there and experts engage a lot there too. Spanish Digital Nomad Visa (DNV)”
“Generally U.S. licensing boards don’t look favorably about someone practicing therapy outside of the country even though it is Telehealth with U.S. clients.
I am in the same boat – both Board of Psychology and Board of Social Work gave me the same answer when I inquired about it earlier this year. If you find out something different, I would love for us to be in touch.
Right now I am in the process of increasing my Telehealth coaching practice and training of other professionals on mental health topics to sidestep this issue entirely! This way I can apply for a Digital Nomad visa in the coming year before we move.”
“what state are you in? And how exactly did your board phrase it? I’m wondering what the risk is exactly because I know people with NY psych license who’s been working from abroad for years (private pay). Have things changed recently? I’m in NY.”
“both my licenses are in the state of Minnesota. Currently I live in Florida and have special permission from the state to do only Telehealth with Florida clients – I am not allowed to have a physical office though. As long as I keep my licenses current in MN, I can do Telehealth with both MN and FL clients.
I am also wondering if any insurance company would give you malpractice insurance if you are not physically located in the U.S.?
I guess I need to research some more! Don’t remember now how “exactly” the Boards phrased. It just meant that I cannot see clients for Telehealth who are outside of FL or MN. I have to be physically located in one of these states. Living outside of the country, I cannot see clients under my licensure, even if they are private pay clients.”
“clients have to be in these states where you are licensed, yes. But not you. At least NY doesn’t care where the provider is as long as the patients are in the state where you are licensed.”
“I see US clients – I’m on a spouse visa (married to eu citizen) and will see clients as autónomo and pay taxes here as a tax resident. The tricky part is that the work won’t be considered medical services (as therapists licensed in Spain working with clients in Spain are), so the services are subject to 21% VAT.
(Ironically, my license only cares where my clients are, but Spanish tax law only cares where I am). The workaround (for US clients) is if I work for a US company as a contractor (1099) and then I’m just taxed on income, not income plus each service.
For “ex pat” clients technically you should pay VAT on those per my understanding. That US company can be an LLC or S corp depending on your state’s requirements.”
“European Branch of the American Counseling Association may be of use to you. Also Location Independent Therapists”
“I am an LPC and I have some some research as well. I think you can also see clients in Spain, but you have to be very careful about the terminology you use. I think “psychotherapist” is ok, but you can not use the official title used by the health system in Spain. I’m still researching this, so I’m not sure….”
“Hi! I’m working on this currently. You need to ensure that your malpractice will cover you if you are out of the country but claims are filed in the U.S.”
“A lot depends on your mechanism for Spanish residency. If, for example, you come on a Non-Lucrative Visa, you will be unable to earn active income for the duration of your visa. If you come on a Digital Nomad Visa, you can work, but there are important requirements and tax implications that you’ll need to be okay with. This includes complying with the EU’s GDPR data protection regulations.”
“I would be careful. The Telehealth resolution expired today with the government shutdown. So CMS will not reimburse Telehealth as of today. There is concern that private insurers will follow by the end of the year. There may be exceptions for some services like mental health but there is a lot of uncertainty. Just Fyi. I would worry about making a big move unless your confident in how your getting paid and reimbursed for your services”
“plenty of therapists are private pay and some states have it written I to resolution that Telehealth payment was a here to stay so what your sayings my isn’t giving someone the full picture”
“This is why I just advised caution and to understand where your payments are coming from. State law does not matter as usually States do not pay for services but manage Medicaid which is still federally dispersed and may be subject to government regulations. I’m not trying to be negative but just suggesting caution just in case Telehealth reimbursement is impacted and someone makes a move and then has difficulty with income”
“I’m a cash pay therapist (still stateside), but my understanding has been that insurance, Medicare, and Medicaid don’t reimburse clients for therapists working from out of the country, anyway. If that is the case, the shut down might impact insurance based therapists or clients utilizing superbills across state lines, but not those practicing internationally as cash pay therapists.”
“Join the Digital Nomad Visa Group. I believe, depending on the work you do and how you do it, that if you apply FROM Spain you can get up to 5 years Visa vs if you apply from US.”
Conclusion
From this discussion, it is clear that many therapists are exploring whether the Spanish Digital Nomad Visa can work alongside their existing telehealth practices as a mental health therapist licensed in the United States. Community members highlight that licensing rules, insurance coverage, tax residency, and visa type all play a crucial role in what is actually allowed.
Several contributors mention that some U.S. licensing boards restrict practicing from outside the country, while others focus only on where the client is located. There are also warnings about U.S. tax obligations, Spanish tax residency, VAT on services, and the potential impact of changing telehealth reimbursement rules in the United States.
Join Spainguru’s free Spanish Taxes webinar here.
Overall, the conversation suggests that working remotely from Spain as a mental health therapist may be possible under certain structures, for example via an LLC, a contractor role with a U.S. company, or cash-pay clients, and possibly under a Spanish Digital Nomad Visa. However, careful research with licensing boards, tax professionals, insurers, and possibly specialist consultants is essential before making any long-term move.
Consult with expert immigration lawyers.
FAQ about the Spanish Digital Nomad Visa for Mental Health Therapists
Can a mental health therapist apply for the Spanish Digital Nomad Visa?
Yes, a mental health therapist can potentially apply for the Spanish Digital Nomad Visa if they meet the visa’s income, contract, and structural requirements. Community members mention that having an LLC or working for a practice or company (rather than as a sole proprietor) is often recommended. Each case is different, so it is important to match the visa criteria with how your practice is set up.
Can I do telehealth with US clients while living in Spain?
Some therapists in the discussion report that they see US clients remotely while living abroad, but this depends heavily on your state licensing board and your malpractice insurance. Certain boards require you to be physically located in the state, while others only care that the client is in the state where you are licensed. Because of this variation, therapists are encouraged to check directly with their own board and insurer.
How does tax residency work if I move to Spain on a Spanish Digital Nomad Visa?
Members highlight that if you stay in Spain more than 6 months per year, you are generally considered a Spanish tax resident. This means you may pay Spanish tax on your worldwide income, including telehealth income from US clients. Some also mention exploring US state tax rules, foreign tax credits, and the impact of working through an LLC or as a contractor.
Are therapy services from Spain subject to VAT?
One therapist notes that, for US clients, their services may not be treated as exempt “medical services” in Spain and therefore can be subject to 21% VAT. The post suggests a possible workaround if you work as a contractor for a US company so that only income tax applies rather than VAT per session. However, the specifics depend on how your work is classified under Spanish tax law.
Do US licensing boards allow therapists to practice from outside the country?
Several comments suggest that some US boards “don’t look favorably” on therapists providing telehealth from abroad, while others mainly regulate where the client is located. One member reports that their Minnesota licenses require them to be physically in certain states for telehealth, whereas another mentions that New York focuses on the client’s location. Because of these differences, direct confirmation from your own board is crucial.
Will US insurance and Medicare reimburse telehealth if I am abroad?
Participants warn that reimbursement rules for telehealth, especially those linked to federal resolutions and CMS, may change and can be affected by government shutdowns. Some believe that insurance, Medicare, and Medicaid often do not reimburse when the therapist is outside the US. Cash-pay models may be less affected, but therapists relying on insurance-based income are advised to be extra cautious.
Can a mental health therapist work in Spain with expat or local clients?
There are comments suggesting that you might be able to see clients in Spain but must be very careful about the professional title you use. For example, some mention that “psychotherapist” may be acceptable, but official health-system titles are regulated. Therapists are still researching this area, and specialist legal or professional advice in Spain is strongly recommended.
Are there support groups or resources for therapists planning to move to Spain?
Yes, several supportive communities and resources are mentioned, including The Traveling Therapist, Location Independent Therapists, European Branch of the American Counseling Association, and Spanish Digital Nomad Visa groups. There are also consultants who specialize in helping therapists set up practices in Spain and navigate legal, ethical, and administrative issues.
Is the Spanish Digital Nomad Visa always better than the Non-Lucrative Visa for therapists?
Not necessarily. One member points out that on a Non-Lucrative Visa you generally cannot earn active income, which makes it unsuitable if you plan to keep working. The Spanish Digital Nomad Visa, on the other hand, allows work but comes with specific requirements, tax obligations, and compliance duties like GDPR. The best option depends on whether you plan to keep working or retire.
What first steps should a mental health therapist take before moving to Spain?
According to the conversation, useful first steps include joining specialized therapist groups, confirming rules with your licensing board and malpractice insurer, and speaking to tax professionals about US and Spanish obligations. Many also recommend learning more about the Spanish Digital Nomad Visa, exploring LLC or contractor structures, and considering whether a cash-pay model might offer more flexibility.
This article is based on personal opinions from the Spainguru community and is not legal advice.
