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Can a California therapist work remotely? The Board says yes.
In short
Can I see California clients from abroad?
The Board's own answer, then the same practice priced in eight places
+$18,700 at the best of the eightThe interesting question is not whether you may — it is what it costs. The same practice, same clients, same profit, priced against eight places on your own numbers.
See what each place leaves you ↓“Can a California licensee while out-of-state provide telehealth services to a client located in California?” Board of Behavioral Sciences telehealth FAQ — and the answer it gives is yes.[1]
Worked example — a $200 hour, 25 sessions a week, filing single. Put your own numbers in below and all three become yours.
Your license is not the obstacle
What the Board actually says
The Board of Behavioral Sciences was asked this directly, and answered: yes — if the license is current and active, the case is appropriate for telehealth, and the licensee follows 16 CCR §1815.5.[1]
That regulation sets standards for the session itself, including verbally obtaining and documenting the client’s full name and present location at the start of every one. It sets no requirement at all about where the licensee is.[2]
Which puts the constraint somewhere other than where most people assume. Your license covers clients in California, so your clients stay in California. You are the one who moves.
What then binds is not California. It is the country you move to: its own rules about practicing a regulated profession on its soil, and whether your visa permits you to work at all. Neither is a Board question, and neither is priced below.
What eight places would leave you
Four numbers. Everything below is computed from them.
The biggest gap
—
Put a rate and caseload in above.
The tax follows the passport, not the address
The United States taxes citizens on worldwide income wherever they live. In a high-tax country the foreign tax credit absorbs most of the US bill, which is why Berlin and Bordeaux above land close to their local tax and not much above it. In a low-tax country there is nothing to credit, so the US bill arrives in full.[4]
And the foreign earned income exclusion — the thing everyone reaches for first — does not touch self-employment tax. The IRS is explicit: you must count all your self-employment income even if the exclusion removed it from your gross income.[3] A self-employed therapist in Dubai still owes the full 15.3% on the way through, on top of whatever the UAE charges.
Which is why the top of that list is a smaller win than “no income tax” would suggest.
This is a comparison, not a plan. It prices tax and nothing else: not visas, not the right to work, not health cover, not what a flat costs in Lisbon against Fresno, not currency risk, not the time-zone question, and not whether a treaty changes your position. Treat it as a reason to ask a cross-border accountant a better question.
Before any of this matters
Every figure here is downstream of one number: what the practice clears before tax. If that is a guess, this page is a guess about a guess.
Build the profit properly →Sources
Estimates, not advice. This models a California-resident sole proprietor with no other household income and no itemized deductions, and prices each location on its headline resident rules. It ignores treaty positions, transition years, exit taxes, state residency-severance rules and anything specific to you. Talk to a cross-border accountant before acting on it.
Practice
Filling the week, and running the admin behind it.