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Exam Overview
An Overview of the NCMHCE
The NCMHCE is the clinical licensure examination developed by the National Board for Certified Counselors. Many state boards use it, alone or with the National Counselor Examination, to license professional and mental health counselors, and it is required for NBCC's Certified Clinical Mental Health Counselor credential. Unlike a knowledge test, every question sits inside a clinical case, so the exam measures applied judgment.
11
Case studies
100
Scored questions
225
Minutes of exam time
4
Options per question
Exam Format at a Glance
| Feature | Details |
|---|---|
| Case studies | 11 clinical case studies; 10 are scored and 1 is an unscored field-test case that is not identified |
| Questions | 9 to 15 multiple-choice questions per case (about 130 to 150 in total); 100 are scored |
| Case structure | Each case presents an initial intake summary followed by two subsequent counseling sessions, with questions after each section |
| Navigation | Once you continue to the next section of a case, you cannot review or change earlier answers in that case |
| Total appointment | 255 minutes: 5-minute nondisclosure agreement, 10-minute tutorial, 225 minutes of exam time, and a 15-minute scheduled break after the fifth case study |
| Developed and administered by | National Board for Certified Counselors (NBCC) |
| Used for | State counselor licensure in many states; the Certified Clinical Mental Health Counselor (CCMHC) credential; an exam option for the National Certified Counselor (NCC) credential |
| Question format | Four-option multiple choice, grouped under clinical case studies |
| Delivery | Pearson VUE test centers or online through OnVUE remote proctoring |
| Retakes | Permitted after a 30-day waiting period |
| Scoring | One point per scored question (maximum 100). The passing score is set by a standard-setting study with subject-matter experts and adjusted for each form through statistical equating; results are reported as pass or fail |
| Fees and registration | Registration is through NBCC (or your state board's NBCC pathway). The fee has been $275 for state licensure candidates; rescheduling costs $50. Confirm current fees when you register. |
| Testing window | State licensure candidates receive up to a 6-month authorization window after approval |
| Score reporting | Official scores are sent to the candidate's state licensing board within about 30 days of the end of the monthly testing cycle |
Content Domains
NBCC's content outline organizes the exam into six domains. Five carry item weights; the sixth, Areas of Clinical Focus, describes the conditions and populations the case studies are built around (adjustment, grief, depression, anxiety, trauma, substance use, suicide risk, relationship and family concerns, and many more), so it is assessed throughout the exam rather than as a separate block of items.
Weighted Domains (percent of scored items)
| Domain | Weight | Typical case questions |
|---|---|---|
| Professional Practice and Ethics | 15% | Informed consent, confidentiality limits, duty to warn, mandated reporting, documentation, telehealth, insurance, supervision |
| Intake, Assessment, and Diagnosis | 25% | Interviewing, mental status, risk assessment, screening instruments, DSM-5-TR diagnosis, level of care |
| Areas of Clinical Focus | Assessed across all cases | The presenting conditions and populations each case is built on |
| Treatment Planning | 15% | Prioritizing problems, goals and objectives, referral, revising the plan, discharge |
| Counseling Skills and Interventions | 30% | Choosing and applying evidence-based interventions, crisis response, group and family work |
| Core Counseling Attributes | 15% | Empathy, genuineness, multicultural sensitivity, self-awareness, non-judgment |
Coming Change: New Examination Specifications
NBCC has published new NCMHCE specifications that take effect on July 1 of the coming exam cycle (see nbcc.org for the date). The new exam uses 10 case studies with 130 to 150 four-option questions (30 to 50 unscored field-test items), 225 minutes, six new domains, and a scaled score from 100 to 500 with a passing score of 360. Candidates who test before the effective date take the format described above. Check your test date against the effective date when you register.Why the NCMHCE Matters
- Licensure: passing the NCMHCE is a requirement or an accepted option for counselor licensure in many states; check your state board's rules.
- Certification: the exam is required for the CCMHC credential and accepted for the NCC credential.
- Competence: the case format verifies that a counselor can assess, diagnose, plan, and intervene safely and ethically.
- Career: licensure opens independent practice, insurance reimbursement, and supervisory roles.
Always Confirm Current Details
Fees, scheduling rules, and state requirements are set by NBCC and state boards and can change. Check nbcc.org and your state licensing board before you register.Finished reading?
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