NCE or NCMHCE: which one do you actually need?
The two exams test different things, and your state board, not you, decides which one counts. How to find out and what the choice means for study.
By Dr. Andrew Wichterman · September 15, 2026 · 6 min read · Updated October 20, 2026
NBCC owns two counselor exams. The National Counselor Examination (NCE) is a 200-item knowledge exam across six content domains. The National Clinical Mental Health Counseling Examination (NCMHCE) is a case-study exam that tests clinical decision-making. Both are used for licensure in all fifty states, the District of Columbia, Puerto Rico and Guam. Which one you take is not your choice in most states.
Your board decides
Each state licensure board sets its own requirement. Some require the NCE. Some require the NCMHCE. Some require the NCE for the initial license and the NCMHCE for the clinical license. Some accept either. A few require both, though that group is shrinking. NBCC publishes no single national table; the authoritative source is the NBCC State Board Directory, which lists each state's licenses and required exams, and your board's own site.
When you have a choice
If your state accepts either exam, consider three things. First, where you might live later: passing the exam a future state requires can save you a second exam and a second fee. Second, how you test: the NCE rewards broad recall; the NCMHCE rewards clinical reasoning under a case format. Third, timing: the NCMHCE assumes clinical experience, and students with little of it often find the NCE more approachable. For NCC certification, NBCC accepts either.
What each exam looks like
- NCE: 200 multiple-choice items, 160 scored, 225 minutes. Six content domains, weighted unevenly. Older prep materials still talk about eight content areas because the exam used to be organized around the eight CACREP areas.
- NCMHCE: 11 case studies (10 scored), 130 to 150 items of which 100 are scored, 255 minutes. NBCC's content outline lists six domains, but only five are scored item by item; the sixth, Areas of Clinical Focus, is carried by the diagnoses the cases are built around.
The formats above come from NBCC's NCE content outline and NCMHCE content outline, the documents NBCC links from each exam's page.
The 2027 redesign
Both exams change on July 1, 2027. The NCE drops to 170 items with three answer options, and both exams move to a 100 to 500 scaled score with 360 as the passing point. If your test date could land near that line, choose materials for the version you will face.
How to check
- Open your state board's licensure requirements page and note the exam named for each license level.
- Cross-check in the NBCC State Board Directory.
- If the two disagree, the board is right. Email them and keep the reply.
Which is harder?
Neither, in any general sense. The NCE is 200 multiple-choice items across six domains and rewards breadth: theorists, criteria, ethics codes, statistics. The NCMHCE presents clinical case simulations and rewards depth of judgment: what to assess first, what the diagnosis is, what to do next. Candidates who did well in coursework tend to prefer the NCE; candidates with clinical hours under supervision tend to prefer the NCMHCE. If your board allows either, choose the one that matches how you learn, not the one a friend found easier.
Can you take both, and should you?
You can. The NCC credential accepts either. Some counselors take the second exam years later when they move to a state that requires it or when they want a clinical credential such as the CCMHC, which requires the NCMHCE. Unless your board requires both or you plan to move soon, take the one your license needs and spend the money you save on supervision hours.
How preparation differs
For the NCE: flashcards for names, numbers and criteria; timed mixed-domain practice sets; a written plan weighted by domain. For the NCMHCE: case walkthroughs, practice choosing assessment and intervention steps in sequence, and fluency with DSM-5-TR differential diagnosis. This site covers both. The NCE side has the course and the item bank; the NCMHCE side has a six-lesson course on working a case, 22 practice cases in the exam's format with an explanation after every question, and its own flashcards.
Cost and logistics are the same
Both exams cost $275 when registered for state licensure, both are scheduled through Pearson VUE inside a window your board approves, and both use the same identification, rescheduling and retake rules. The difference is entirely in what the items ask. If your board accepts either, the decision is about how you think, not about money or convenience.
Check the current handbook. Fees, windows and procedures change. Confirm every specific against the current NBCC candidate handbook and your state board's published rules before you act on it.
Find out which exam before you buy a single flashcard set. Studying for the wrong one is the most expensive mistake on this list.