To be listed in the licensed counselor supervisor directory, an individual provider shall:

(1) Hold a license or retired active license that permits treatment of individuals in the state of Washington without restrictions and have been in good standing for the previous two years, in an eligible profession, including:

(a) Mental health counselor, marriage and family therapist, or social worker under chapter 18.225 RCW;

(b) Psychologist under chapter 18.83 RCW;

(c) Physician practicing as a psychiatrist under chapter 18.71 RCW; or

(d) Psychiatric nurse practitioner under chapter 18.79 RCW.

(2) Submit to the department a completed application on forms provided by the department;

(3) Submit to the department verification of meeting the following education requirements:

(a) A minimum of 15 clock hours of training in clinical supervision obtained through:

(i) A supervision course;

(ii) Continuing education credits on supervision;

(iii) Supervision of supervision; or

(iv) Any combination of these; and

(b) Twenty-five hours of experience in supervision of clinical practice, such as cosupervision with an approved supervisor, supervision of interns, or other similar activities; and

(4) Meet any other qualifications as required by law.