Naturopathic doctors (NDs) are licensed healthcare providers trained in both conventional diagnostics and natural therapeutics. They treat the whole person -- body, mind, and spirit -- using evidence-informed approaches that emphasize prevention, self-healing, and minimally invasive treatments. However, the regulatory landscape for naturopathic medicine in the United States is uniquely complex: only about half of states and territories license naturopathic doctors, and scope of practice varies dramatically from state to state.

This guide walks you through every step of the process, from earning your undergraduate degree to graduating from a CNME-accredited naturopathic medical program, passing the NPLEX examinations, obtaining state licensure, and maintaining your credentials through continuing education. We have compiled verified data for all 51 states and territories we track so you can compare requirements side by side.

What Does a Naturopathic Doctor Do?

Naturopathic doctors use natural therapies alongside conventional diagnostics to treat the whole person. Their therapeutic toolbox includes botanical medicine, clinical nutrition, hydrotherapy, physical medicine, and counseling. Licensed NDs are trained to diagnose and treat medical conditions, order laboratory tests, and -- in states that grant prescriptive authority -- prescribe certain pharmaceutical medications.

It is important to understand that naturopathic doctors are distinct from MDs and DOs. While NDs complete rigorous medical training that includes many of the same biomedical sciences, their philosophical approach emphasizes the body's innate ability to heal, prevention over intervention, and treating root causes rather than symptoms alone. Licensed NDs occupy a unique role in the healthcare system, bridging conventional and integrative medicine.

Common areas of practice for naturopathic doctors include:

• Botanical medicine: Using plant-based remedies and herbal preparations for therapeutic purposes.
• Clinical nutrition: Designing individualized dietary plans and using nutritional supplementation to address health conditions.
• Hydrotherapy: Applying water-based treatments to stimulate circulation, support detoxification, and promote healing.
• Physical medicine: Hands-on therapies including naturopathic manipulation, massage, and therapeutic exercise.
• Counseling and lifestyle medicine: Addressing mental-emotional health, stress management, and behavioral change.
• Homeopathy: A traditional system of medicine using highly diluted substances, included in naturopathic training at all CNME-accredited programs.

The U.S. Bureau of Labor Statistics does not maintain a separate occupational category for naturopathic doctors. Based on available industry data, licensed NDs typically earn in the range of $75,000--$100,000 annually, with variation based on location, years of experience, practice setting, and whether the ND owns a private practice.

Step 1: Education Requirements

Bachelor's Degree

Admission to a naturopathic medical program requires a bachelor's degree with pre-medical prerequisites. While no specific undergraduate major is required, most successful applicants complete coursework in biology, general chemistry, organic chemistry, physics, biochemistry, and psychology. A pre-med or natural sciences background provides the strongest foundation. During your undergraduate years, seek volunteer or clinical experience in healthcare settings to strengthen your application.

4-Year Naturopathic Medical Program (CNME-Accredited)

The core of naturopathic medical education is a four-year, graduate-level program accredited by the Council on Naturopathic Medical Education (CNME). CNME is the programmatic accreditor recognized by the U.S. Department of Education for naturopathic medical programs. Graduating from a CNME-accredited program is required for NPLEX eligibility and state licensure in all licensing jurisdictions.

CNME-accredited naturopathic medical schools include:

• Bastyr University (Kenmore, WA and San Diego, CA)
• National University of Natural Medicine (NUNM) (Portland, OR)
• Sonoran College of Naturopathic Medicine (SCNM) (Tempe, AZ)
• University of Bridgeport -- College of Naturopathic Medicine (Bridgeport, CT)
• Canadian College of Naturopathic Medicine (CCNM) (Toronto, ON)
• Boucher Institute of Naturopathic Medicine (BINM) (New Westminster, BC)
• National University of Health Sciences (NUHS) (Lombard, IL)

The naturopathic medical curriculum includes:

• Biomedical sciences: Anatomy, physiology, biochemistry, pathology, microbiology, pharmacology
• Clinical sciences: Physical diagnosis, laboratory diagnosis, diagnostic imaging, clinical assessment
• Naturopathic therapeutics: Botanical medicine, clinical nutrition, homeopathy, hydrotherapy, physical medicine, counseling
• Clinical rotations: Supervised patient care in teaching clinics and community health settings

Step 2: NPLEX Examinations

The Naturopathic Physicians Licensing Examinations (NPLEX) are the standardized licensing exams for naturopathic doctors in the United States and Canada. The NPLEX is administered by the North American Board of Naturopathic Examiners (NABNE) and is required for licensure in all states that regulate naturopathic medicine.

The NPLEX consists of two parts:

Part I: Biomedical Science Examination

NPLEX Part I covers the basic biomedical sciences and is typically taken after the second year of naturopathic medical school. Content areas include anatomy, physiology, biochemistry, pathology, microbiology, and immunology. This exam ensures candidates have mastered the foundational sciences before advancing to clinical training.

Part II: Clinical Science Examination

NPLEX Part II is taken upon completion of the ND program and covers core clinical science content. The exam includes a core clinical component plus elective sections that may cover minor surgery, pharmacology, acupuncture, and other specialized areas depending on state requirements. Part II assesses clinical reasoning, diagnosis, and treatment planning across the full scope of naturopathic practice.

• Administered by: North American Board of Naturopathic Examiners (NABNE)
• Eligibility: Graduation from (or enrollment in) a CNME-accredited naturopathic medical program
• Format: Computer-based, multiple-choice examinations
• Retakes: Candidates who do not pass may retake the exam; policies are set by NABNE

Of the 51 states we track, 24 require NPLEX as a condition of licensure. Always confirm specific exam requirements with your state licensing board, as some states require additional elective NPLEX sections.

Prescriptive Authority for Naturopathic Doctors

Prescriptive authority -- the legal ability to prescribe pharmaceutical medications -- is one of the most significant scope-of-practice distinctions among states that license naturopathic doctors. Not all licensing states grant prescriptive authority; those that do typically define a specific formulary or list of permitted drug categories.

Of the 51 states we track, 21 grant prescriptive authority to licensed naturopathic doctors. States with prescriptive authority include:

Important considerations regarding prescriptive authority:

• Formulary limitations: Most states with prescriptive authority restrict NDs to a defined formulary. Controlled substances (Schedule I--V) are often excluded or limited.
• Additional training: Some states require NDs to complete additional pharmacology coursework or pass the NPLEX pharmacology elective to qualify for prescriptive authority.
• Collaborative agreements: A few states require NDs to maintain collaborative or supervisory agreements with MDs or DOs in order to prescribe.
• DEA registration: NDs with prescriptive authority who prescribe controlled substances must register with the Drug Enforcement Administration (DEA).

State-by-State Naturopathic Doctor Requirements

Requirements vary significantly by state. Only about half of U.S. states license naturopathic doctors. In states without licensure, anyone may call themselves a "naturopath" but cannot practice medicine, diagnose conditions, or prescribe treatments. Licensed states protect the ND or NMD title and establish clear scope of practice. Click any state name to see its complete licensing guide.

Data sourced from official state licensing board websites, AANP, CNME, and NABNE. Requirements change frequently -- always verify with your state board before applying.

Continuing Education Requirements

Maintaining your naturopathic doctor license requires ongoing continuing education (CE). Requirements vary by state, but all licensing jurisdictions require some form of CE for license renewal.

Across the 51 states we track, the average CE requirement is 39.9 hours per renewal cycle. CE requirements typically include:

• Clinical topics: Courses in naturopathic therapeutics, pharmacology, clinical diagnosis, and other areas directly related to patient care.
• Ethics and jurisprudence: Many states require a portion of CE hours in ethics, professional conduct, or state law.
• Pharmacology: States with prescriptive authority often require specific CE hours in pharmacology or pharmacotherapeutics.
• Approved providers: CE must typically be from approved providers such as CNME-accredited schools, state and national naturopathic medical associations, or other recognized medical CE providers.

Tips for managing CE requirements efficiently:

• Track your hours year-round rather than scrambling at renewal time.
• Attend your state naturopathic medical association's annual conference -- it typically offers multiple CE hours in a single weekend and is a strong networking opportunity.
• Check whether your state accepts CE from AANP-approved providers, as national conferences and online courses may satisfy state requirements.
• If licensed in multiple states, identify overlapping CE requirements to reduce duplication.

Frequently Asked Questions

Sources

The information in this guide is compiled from official sources. We recommend verifying current requirements directly with these organizations before making career or educational decisions:

• American Association of Naturopathic Physicians (AANP)
• Council on Naturopathic Medical Education (CNME) -- Accreditation Standards and Program Directory
• North American Board of Naturopathic Examiners (NABNE) -- NPLEX Examination Information
• Individual state licensing board websites -- see each state page for direct links to official regulatory authorities.