Address and Name Change Information

Address Change

You are required to notify the Indiana Professional Licensing Agency of any address change. You can update your address online, via email at pla8@pla.in.gov, or via fax at (317) 233-4236. You can also submit your address change in writing to:

Indiana Professional Licensing Agency
Attn: Behavioral Health and Human Services Licensing Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

Please include your name, license number or social security number, and both your old and new addresses on any written correspondence.
 

Name Change

You may have the name changed on your licensure records by submitting a copy of a legal name change document (marriage certificate, divorce decree, social security card or other legal name change documents).  Submit name change requests and documentation to:

Indiana Professional Licensing Agency
Attn: Behavioral Health and Human Services Licensing Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

Please include your name as it is listed now, your new name, and your license number or social security number on all correspondence.