Licensee / Facility Name ________________________________ 
License Type __________________________  
License Number ________________________                                                                                                               
Verification will be emailed to: 
 
 
*Please attach authorization to request a license verification if you are not the license holder. Remit this form and                           
$10.00 fee (7 calendar days processing time); $35.00 fee (48 hours processing time) per provider. 
                                                                                                     
Acceptable forms of payment are: credit card authorization form (below), certified check or money order, made 
payable to “GOV’T of the VI” to: 
 
Professional Licensure and Health Planning 
c/o VI Department of Health-STX  
P.O. Box 222995 
Christiansted, VI 00822  
 (340) 773-1561 Ext. 4431 
 plhpverify@doh.vi.gov 
 
  
 
 
 
 
 
LICENSE TYPES
(DC) -Chiropractic
(DDS, DMD) -Dentistry                                         
(RDH) -Dental Hygienist      
(MD, DO) -Medicine and Surgery                                 
(PA, PA-C) -Physician Assistant                          
(PSY, PSYD, MA Psych Assoc.) -Psychologist
(RPH, PharmD) -Pharmacist                                          
(CPTI, CPT, RPT, PPT) Pharmacy Technician             (CTO, OD) -Optometry
(PT, DPT) -Physical Therapy
(PTA) -Physical Therapy Assistant
(DPM) -Podiatry
(DVM) -Veterinary Medicine                                 
(RVT)-Veterinary Technician
(RRT) -Radiology Technician                                   
CON) -Certificate Need                                                      Pharmacy
(ND, OT, MT) -Allied Health Clearance Letter        
Other: ___________________________________ 
Name 
 
Contact Person 
 
Agency 
 
Email Address 
 
OFFICE OF PROFESSIONAL LICENSURE AND HEALTH PLANNING 
P.O. Box 222995 
CHRISTIANSTED, VI 00822-2995 
 
License Verification / Good Standing Letter Request & Invoice 
Signature 
     Date