Tax for licensed mental health practices
A CPA for therapists in private practice
Solo and group practices, LCSW through LMFT. The return is the easy part. The decisions that move your number are entity choice, how you pay associates, and which states you have created a filing obligation in without noticing.
Where this return differs
What is actually different about therapists at tax time
Not a longer version of the same advice. These are the places this practice type reliably differs from the return next to it.
Telehealth creates filing obligations
Seeing a client who has moved to another state can create income tax nexus there, and the licensure compacts that made the clinical side portable did nothing to the tax side. This gets caught at filing when it is expensive, or during the year when it is not.
Associates are a classification question, not a payroll question
Whether a supervisee or contracted clinician is an employee or an independent contractor is decided by the facts of the arrangement, not by which one is cheaper. Getting it wrong is an employment tax exposure that compounds every quarter it continues.
Reasonable compensation has to be defensible
An S corporation election only helps if the salary you pay yourself can be supported. Clinical licensure, caseload, and whether you also run the practice all bear on it, and the number needs a basis you could show someone.
How it works
What working together looks like
A call first
Thirty minutes to hear what you have and whether this is a fit. If it is not, we will say so and point you somewhere useful.
A written scope and a fixed fee
You get both in writing before work starts, so the return you expected does not arrive with an hourly surprise attached.
Documents through a secure portal
Upload once, in one place, rather than emailing a K-1 with your Social Security number sitting in the attachment.
The questions, while they still matter
Anything that changes your number gets raised when it can still be acted on, not in a footnote after filing.
Then the next twelve months
Estimated payments, an entity change, a new state, a sale. Tax years are consecutive and treating them that way is most of the value.
What this firm does, and what it does not
PizzelloCPA, PLLC is a licensed CPA firm registered with the North Carolina State Board of Certified Public Accountant Examiners as firm no. 35339. It prepares returns and does tax planning. It does not perform attest services: no audit, no review, no compilation. If a lender or a landlord has asked you for an audited or reviewed financial statement, that is a different engagement at a different firm, and we will say so rather than stretch to fit it.
Books and the return are two different jobs. bookkeepz, LLC, an affiliated company, keeps monthly books for therapists and other private practices, and its bookkeeping page for therapists covers that side. bookkeepz is not a CPA firm and does not do tax work. Most clients who need both use both, under separate engagements.
Questions
What therapists ask
I see clients in more than one state. What does that do to my return?
It can create a filing obligation in each of those states, and the rules differ by state rather than following your license. The practical answer is to identify where you actually have clients before the year closes, because the fix is usually simple in advance and rarely simple afterward.Should my practice be an S corporation?
It depends on profit, on what a defensible salary looks like for your role, and on the payroll cost the election adds. It is worth running once the practice is consistently profitable, and worth revisiting after a year that changed materially. There is no profit number that makes it automatic.Do you handle the QBI deduction for a therapy practice?
Yes, and it is worth understanding that a therapy practice is a specified service trade or business, so the deduction phases out as income rises rather than applying at every level. Planning around that phaseout is the part that matters.Do you also keep my books?
No. This firm prepares returns and does tax planning. bookkeepz, LLC, an affiliated company, keeps monthly books and is not a CPA firm. Most clients who need both use both, under separate engagements.Talk to a CPA who has seen this practice before
Thirty minutes, no charge. Bring last year’s return and the thing you were not sure about.