Both the NCE and the NCMHCE are counseling exams administered by NBCC, and your state board decides which one you take. The NCE is a 200-question multiple-choice test (160 scored) used for the National Certified Counselor credential and for licensure in many states. The NCMHCE is a case-study exam — 11 clinical case narratives with multiple-choice questions (100 scored) — most often required for clinical-level counseling licensure. Some states require one, some the other, and some use both at different license tiers.
If you're working toward a counseling license, two acronyms come up almost immediately: the NCE and the NCMHCE. They're both published by the National Board for Certified Counselors (NBCC), they're both delivered at Pearson VUE test centers, and they both stand between you and the license you want — but they test very different things, in very different ways, and they lead to different credentials.
This guide walks through both exams in plain English: who each is for, what credential or license it unlocks, what the test actually looks like today, and — most importantly — how to know which one you sit for.
The short answer: your state board decides
You don't choose between the NCE and the NCMHCE based on preference. Your state's professional counseling licensing board specifies which exam (or exams) you must pass for the license you're applying for. Counseling license titles vary widely from state to state — LPC, LMHC, LCMHC, LPCC, LMHP — and so do the exam requirements attached to them. The practical sequence is almost always:
- You apply to your state board for the counseling license you want.
- The board tells you which NBCC exam it requires for that license tier.
- You register through NBCC, receive authorization, and schedule at a Pearson VUE center.
Because of this, the single most reliable thing you can do before you start studying is read your own state board's current requirements. The same license title can carry a different exam requirement two states over.
The two exams
National Counselor Examination (NCE)
Who takes it: Counselors-in-training and recent graduates pursuing the National Certified Counselor (NCC) credential, and candidates in the many states that require the NCE for counselor licensure. It's frequently the first NBCC exam a counselor encounters, and many graduate students sit for it through their program via NBCC's graduate student application process.
What it leads to: The NCC certification (NBCC's national board certification) and, in many jurisdictions, state counselor licensure. A single NCE pass can satisfy both purposes where the state accepts it.
Format: 200 multiple-choice questions in a single, non-sectioned form. 160 of those items are scored and 40 are unscored field-test items, so the maximum possible score is 160. Candidates get a total test session of 255 minutes (4 hours and 15 minutes). The content is built on the eight CACREP common-core curricular areas and organized for scoring around NBCC's work-behavior domains — professional practice and ethics, intake and assessment, clinical focus areas, treatment planning, and counseling skills and interventions.
National Clinical Mental Health Counseling Examination (NCMHCE)
Who takes it: Counselors pursuing clinical-level or independent licensure — the credential that authorizes independent diagnosis, treatment, and (in most states) third-party reimbursement. In many states the NCMHCE is the exam required at the clinical tier, sometimes after the NCE has already been passed at an earlier stage.
What it leads to: Clinical mental health counseling licensure — LCMHC, LPCC, or the clinical/independent tier of an LPC or LMHC, depending on the state.
Format (redesigned in 2023): A case-study exam rather than a standalone multiple-choice test. It presents 11 clinical case studies — 10 scored and one unscored — each a narrative distributed across three sections: an initial intake summary and two subsequent counseling sessions. Each case carries a set of multiple-choice questions (four options, one correct answer), and roughly 100 questions are scored in total. Candidates get 225 minutes of examination time within about 260 minutes of total seat time (including the tutorial and a break). Notably, the client's diagnosis is provided at the start of each case, which shifts the emphasis away from diagnosis-guessing and toward treatment planning, intervention selection, counseling skills, and sound clinical decision-making across the arc of care.
How they compare at a glance
- Question style: NCE — standalone, knowledge-based multiple choice. NCMHCE — multiple-choice questions nested inside clinical case narratives.
- Scored items: NCE — 160 scored of 200. NCMHCE — about 100 scored across 10 scored case studies.
- Time: NCE — 255 minutes total session. NCMHCE — 225 minutes of testing (about 260 minutes seat time).
- What it measures: NCE — breadth of foundational counseling knowledge. NCMHCE — applied clinical judgment across assessment, treatment planning, and intervention.
- Typical role: NCE — certification and entry/standard licensure. NCMHCE — clinical/independent licensure.
The common decision paths
Path 1: NCE for certification and licensure
You graduate from a counseling program, sit for the NCE (often as a graduate student through your program), earn the NCC credential, and use that same NCE pass to satisfy your state's licensure exam requirement where the state accepts it. This is the most common entry point into the profession.
Path 2: NCMHCE for clinical licensure
Your state requires the NCMHCE for the clinical or independent counseling license. You complete your supervised postgraduate hours and sit for the case-based NCMHCE to earn LCMHC, LPCC, or the clinical tier of your state's LPC/LMHC. This is the gateway to independent diagnosis and treatment and, in most states, to insurance reimbursement.
Path 3: both, at different stages
A number of states use both exams — the NCE earlier and the NCMHCE at the clinical tier — or accept either one for a given license. If your board falls into this group, confirm the exact sequence and timing so you're not registering for the wrong exam at the wrong stage.
If you want a profession-by-profession, state-by-state view of which exam your license requires, Triad maintains a free Path to Licensure reference with a direct link to each official state board.
Pass rates and preparation
The two exams reward different preparation. The NCE rewards broad, well-organized content mastery across the CACREP core areas — it's a knowledge exam, and structured content review with heavy practice testing maps to it cleanly. The NCMHCE rewards clinical reasoning under a case narrative: reading an intake, prioritizing next steps, choosing interventions, and tracking a client across sessions. Candidates who only memorize facts often find the NCMHCE harder than they expected, because it tests judgment rather than recall.
NBCC publishes outcome data for both exams, and Triad maintains its own national first-attempt pass-rate research across counseling and the other behavioral health licensure exams. Two durable takeaways for planning: build in a structured study window of three to four months rather than cramming, and — especially for the NCMHCE — practice with full-length, case-based simulations so test day isn't the first time you work a case end to end.
Prep for the right counseling exam.
AATBS — a Triad brand — has authored counseling licensure prep for decades, with full coverage of the NCE, the redesigned case-based NCMHCE, and the CPCE. Diagnostic testing, content review mapped to the current blueprints, large practice-item banks, and full-length simulated exams built for each format.
Explore Counseling Exam Prep →Sources & further reading
- National Board for Certified Counselors (NBCC), National Counselor Examination (NCE). nbcc.org/exams/nce
- NBCC, National Clinical Mental Health Counseling Examination (NCMHCE). nbcc.org/exams/ncmhce
- NBCC, NCMHCE Transitioning to New Format and the NCMHCE Format Comparison Chart — details of the 2023 case-study redesign.
- NBCC, Candidate Handbook for State Licensure (NCE and NCMHCE editions) — current item counts, timing, and content outlines.