Frequently Asked Questions

Psychiatry is a branch of medicine focused on diagnosing and treating mental health conditions using both medical and psychological approaches.

Psychiatrists consider how emotional, cognitive, and physical health interact, recognizing that symptoms such as anxiety, mood changes, or sleep disturbances can have medical, psychological, or social origins.

The goal of psychiatry is accurate diagnosis and the thoughtful treatment of mental health conditions in order to reduce suffering and improve functioning.

A psychiatrist is a medical doctor (M.D. or D.O.) who specializes in mental health. Psychiatrists complete four years of medical school followed by four years of residency training in psychiatry. This medical training allows them to evaluate how psychiatric symptoms may relate to underlying medical conditions, medications, or neurological factors. Psychiatrists are trained to provide comprehensive psychiatric care, including diagnosis, medication management, and coordination with other healthcare professionals when appropriate.

Psychiatrists and therapists both support mental health, but their roles differ. Psychiatrists are physicians who diagnose psychiatric conditions and can prescribe and manage medications. Therapists provide talk therapy focused on coping skills, relationships, and emotional well-being.

Starting with a psychiatrist is often appropriate when medication may be needed, when symptoms are worsening, or when mental health concerns are affecting sleep, work, or daily functioning. Therapy may be the first step when the primary goal is skills-based counseling for stress, relationships, or coping. Many individuals benefit from a combination of both.

With the patient’s permission, psychiatrists and therapists may coordinate care so that medication management and psychotherapy work together effectively. This collaborative approach helps ensure that treatment goals are aligned and that important clinical information is shared when appropriate. Referrals to trusted local therapists are available for patients who are not already engaged in therapy.

Physician-level training is particularly valuable when symptoms may overlap with medical conditions; when multiple medications are involved; when prior treatments have been ineffective; during pregnancy or preconception planning; when neurological concerns are present (such as seizures or head injury); or when side effects or potential drug interactions require careful medical review.

Several types of professionals provide mental health care. In addition to psychiatrists, some patients receive treatment from psychiatric nurse practitioners (PMHNPs), physician assistants, psychologists, or therapists—each with a distinct background and level of training.

Psychiatric nurse practitioners, for example, are advanced-practice nurses (APRN) who may prescribe medication and provide follow-up care, and many offer thoughtful, effective treatment within their scope of practice.

At Northeast Texas Psychiatry, all care is provided directly by physicians—medical doctors with residency training in psychiatry. This ensures that evaluations and medication management are overseen by clinicians with comprehensive medical training, which is particularly valuable when symptoms or treatments may intersect with other health conditions.

The depth of training directly influences the scope and complexity of care that can be provided. Psychiatrists are physicians who complete medical school, a four-year psychiatry residency, and tens of thousands of hours of supervised clinical experience across medicine, neurology, and psychiatry. This comprehensive background allows them to evaluate mental health concerns in the broader context of physical health—recognizing when psychiatric symptoms may stem from medical, neurological, or pharmacologic causes.

Psychiatric nurse practitioners (PMHNPs) are advanced-practice nurses with graduate-level training in psychiatric care. Their programs include specialized coursework and typically several hundred hours of supervised clinical experience. Many provide thoughtful, capable care within their scope of practice. Their total supervised psychiatric training, however, is generally about 10 to 20 times less than that of a psychiatrist.

Approximate Training Comparison:
In other words, psychiatrists complete over 10 times more total supervised clinical training and 15 to 20 times more psychiatry-specific training than psychiatric nurse practitioners. Both play important roles in mental health care, but physicians bring a deeper medical foundation that becomes critical when psychiatric, medical, and neurological factors overlap. At Northeast Texas Psychiatry, all care is provided directly by physicians, ensuring that each evaluation and treatment plan benefits from comprehensive medical expertise.

In Texas, physicians, including psychiatrists (M.D./D.O.), have full prescribing authority as part of the practice of medicine. This includes prescribing psychotropic medications used to treat mental health conditions.

Advanced Practice Registered Nurses (APRNs), including nurse practitioners, and Physician Assistants (PAs) may prescribe medications pursuant to a written delegation arrangement (a prescriptive authority agreement) with a physician, as permitted by Texas law and applicable regulations.

Note: In Texas, nurse practitioners do not prescribe independently; their authority to prescribe is derived from a prescriptive authority agreement with a physician.

Under Texas law, physicians may delegate the act of prescribing or ordering drugs and medical devices to APRNs and PAs through a written Prescriptive Authority Agreement (PAA), as permitted by Texas law and applicable regulations. The agreement must be signed, dated, and include key elements such as the scope of delegated prescribing and how care is coordinated.

Physicians who delegate prescriptive authority must register with the Texas Medical Board, as required by applicable regulations.

Texas law does not require that a psychiatric nurse practitioner (PMHNP) or physician assistant providing psychiatric care be supervised by a psychiatrist specifically. The delegating physician may be from any medical specialty (including surgery, internal medicine, pediatrics, etc.), provided the delegation arrangement complies with applicable Texas laws and regulations.

Texas law also does not require the delegating physician to be located in the same city as the psychiatric NP or PA. However, the physician must maintain appropriate supervision, oversight, and chart review as required by Texas law and the physician–delegation agreement.

The structure of physician delegation, prescriptive authority, and supervision requirements depends on the practice setting and must comply with Texas statutes and regulations governing delegated medical practice.

The delegating physician remains responsible for the medical care delivered under their delegation and must ensure that the delegated activities are within the physician’s own scope of training and competence.

No. In Texas, psychologists (Ph.D./Psy.D.) do not have prescriptive authority. Their training and licensure focus on psychological assessment and psychotherapy rather than the medical prescribing of medications.

APRNs complete graduate-level nursing education (often at the master’s or Doctor of Nursing Practice [DNP] level) with clinical specialty training. PAs complete accredited graduate-level medical training with supervised clinical rotations. Their roles, scope of practice, and ability to provide medical and psychiatric care, including prescribing under delegation, is defined by their education, licensure, and applicable Texas law.

It is appropriate to ask your clinic who is responsible for your psychiatric diagnosis, medication management, and overall treatment plan. You may also ask how physician oversight and delegation are structured within your care team. Clear understanding of roles supports transparency, coordinated care, and informed decision-making.

Patients have the right to know who is responsible for their diagnosis, treatment planning, and medication management. In Texas, when care involves physician delegation to a physician assistant (PA) or advanced practice registered nurse (APRN), patients may ask:

• Who is the delegating or supervising physician?
• How can I contact the physician if needed?
• How is oversight structured in this practice?

Patients may also verify licensure and, when applicable, delegation relationships through publicly available state licensing board resources:

• Texas Medical Board (for physicians and physician assistants): tmb.state.tx.us
• Texas Board of Nursing (for advanced practice registered nurses): bon.texas.gov

Clinic staff should be able to provide this information upon request. Asking these questions supports transparency, accountability, and informed decision-making.

Regulatory requirements and scope of practice are defined by Texas law and may change over time. Patients are encouraged to ask their care providers about credentials, roles, and oversight in their specific care setting.

We include this information because patients deserve clear, honest information about who is providing their care and how psychiatric treatment is structured under Texas law.

At times, marketing materials describe psychiatric nurse practitioners and psychiatrists in ways that suggest their legal authority, scope of practice, and independence in patient care are essentially the same. In Texas, they are not. Physicians practice medicine under their own licenses. APRN prescribing and other delegated medical acts in Texas occurs within a physician-delegation framework governed by state law and supervision requirements rather than under an independent physician license.

In addition, not all psychiatric nurse practitioners are supervised by psychiatrists. In Texas, the delegating physician is not required to practice in the same specialty.

We are not including this to disparage anyone. Titles, training pathways, scope of practice, and legal authority are not identical, and patients should understand these differences when deciding who they want responsible for directing their diagnosis, medication management, and overall treatment plan.

We offer outpatient psychiatric assessments and medication management for adults. Our focus is on conditions such as depression, anxiety, bipolar disorder, PTSD, OCD, sleep problems, and stress-related concerns. If therapy or counseling would be helpful, we can provide referrals to trusted therapists in the community.

No. Our practice focuses on the care of adults only.

Start by completing the New Patient Request Form (Psychiatric History Record). For a full step-by-step overview, see Learn about our new patient review process on the New Patient Request page.

Yes. Initial evaluations are in person. Some follow-up visits may be offered by telehealth when appropriate, and the patient must be physically in Texas for any telehealth visit.

The initial evaluation is comprehensive and includes a detailed psychiatric and medical history, a review of current and past treatments, a diagnostic assessment, and a collaborative discussion of treatment options and next steps.

Our goal is to understand the full clinical picture and develop a safe, individualized treatment plan. Initial appointments typically require up to 60 minutes. If additional time is needed, a prompt follow-up appointment can be arranged.

At times, laboratory testing or other medical evaluations may be recommended. If symptoms or history suggest a possible medical contribution—such as thyroid dysfunction, vitamin deficiencies, medication effects, or sleep-related issues—appropriate tests may be ordered. Labs are obtained only when clinically indicated, and results are reviewed during follow-up. Periodic laboratory monitoring may also be required for certain medications to ensure continued safety.

Treatment decisions are guided by evidence-based standards, patient preferences, and clinical history. Some conditions respond best to a combination of medication and therapy, while others may be managed effectively with one approach alone. The treatment plan is adjusted over time based on clinical response.

Follow-up frequency is individualized based on clinical need, treatment goals, and stability. Some patients are seen more frequently during periods of medication changes or symptom exacerbation, while others may be followed at longer intervals when stable.

Before the first appointment, patients receive links to complete two forms: the Office Policies form and the New Patient Agreement form. These should be completed in advance; reminder notices are sent if they remain unfinished. On the day of the visit, a valid photo ID and preferred payment method are required. Arriving 5–10 minutes early is recommended, as the office remains locked between appointments.

Appointment length varies depending on the type of visit and clinical needs. Each visit is structured to address current concerns, review safety and treatment response, and outline next steps. Initial appointments typically require up to 60 minutes, and follow-up visits up to 30 minutes. If additional time is needed, a prompt follow-up appointment can be arranged.

Please provide at least 24 hours’ notice for cancellations or rescheduling. Frequent last-minute cancellations or missed appointments may affect a patient’s ability to continue receiving care at the practice.

If the first appointment is missed, rescheduling may not be offered. Prospective patients are encouraged to ensure they can attend at the scheduled time.

Visits are by appointment only. The office remains locked between appointments, so arriving 5–10 minutes before the scheduled time is recommended.

Regular appointment hours are Monday through Thursday, 9 AM–5 PM.

We’re a private, appointment-only clinic. The office is locked between visits, so we’re not open for walk-ins. Please contact us by phone, text, or email and we’ll be glad to help.

Family members or friends are welcome to attend appointments if the patient wishes. Guests should plan to remain in the room for the duration of the visit.

Medication refills are processed during business hours and may require up to one business day. Patients are encouraged to plan ahead to avoid running out of medication. Refill requests are not addressed after hours.

Most medication refills require an appointment to ensure treatment remains safe and effective. Patients are encouraged to plan ahead to avoid gaps in medication.

Patients should contact the clinic promptly if side effects occur or concerns arise regarding medication. The treatment plan can then be adjusted as needed. For urgent safety concerns, call 911 or go to the nearest emergency department.

Controlled medications may be prescribed when clinically appropriate. If included in a treatment plan, safe use is reviewed in detail and questions are addressed. All prescribing decisions are based on clinical needs and professional judgment.

No. We do not prescribe opioids or other medications for pain management. For pain-related needs, please consult a primary care provider or pain specialist.

New evaluations (in-person only): $350
Follow-up visits: $150 (in person, or sometimes by telehealth if appropriate)

Payment is collected before the appointment. We accept cash, checks, and major credit cards (Visa, Mastercard, Discover, American Express).

The practice does not contract with insurance companies, Medicare, or Medicaid. All visits are self-pay at the time of service.

Some patients with out-of-network benefits choose to submit documentation for potential reimbursement; reimbursement is determined solely by the insurer and the patient’s plan.

We use a direct, fee-for-service model so that clinical decisions are guided by medical judgment rather than insurance requirements or time limits. This allows us to provide thorough evaluations, unhurried follow-ups, and individualized treatment planning. Many patients also appreciate the transparency of knowing the cost of care upfront, without surprise billing.

Some patients with out-of-network benefits may be able to seek partial reimbursement from their insurance plan. We are happy to provide documentation upon request (including an itemized receipt/superbill), though reimbursement is determined by your insurer and plan benefits.

No. Many of our patients carry insurance for hospital care, emergencies, and specialty services, but choose to pay directly for psychiatric care to prioritize time, continuity, and individualized attention in their mental health treatment.

Our practice does not require monthly memberships or retainers. Visits are billed per appointment, and patients are free to schedule follow-ups based on clinical need. This preserves flexibility and avoids ongoing fees when care is not actively needed.

This model works well for patients who value longer visits, individualized care, and transparent pricing. We recognize that different care models suit different needs and circumstances. If you are unsure whether this approach is the best fit for you, we are happy to discuss options and help you think through what level of care may be most appropriate.

Telehealth is available for certain follow-up appointments. All initial visits must be conducted in person. For any telehealth session, Texas law requires the patient to be physically located within the state of Texas.

If another provider requires records, their office may contact the clinic and fax a signed release form.

Patients requesting a personal copy of their records should call the clinic and plan to come in person with a photo ID to complete the request. A limited set of key documents can be provided at no cost; full record copies may be produced for a small fee as permitted under Texas Medical Board rules.

The practice follows all HIPAA guidelines to protect patient health information. Social media is not used for patient communication, and information is shared with other providers only with written authorization or when required by law.

No. In the event of a psychiatric or medical emergency, call 911, 988 (Suicide & Crisis Lifeline), or go to the nearest emergency department.

In a crisis, immediate help is essential:

• Call 911 if there is immediate danger or a need for urgent medical assistance
• Go to the nearest emergency department if safety is a concern
• Call 988 for the Suicide & Crisis Lifeline, which provides 24/7 confidential support
• Seek support from a trusted family member or friend who can assist in the moment

Established patients may contact the clinic once safe and able, so appropriate next steps can be coordinated.

Yes. With appropriate authorization, the clinic coordinates care with primary care physicians, therapists, and other specialists to support comprehensive treatment.

If a patient transitions to another clinician, the clinic will facilitate record transfer once the appropriate release form is received.

The preferred method of communication is through the Spruce secure messaging app/portal.

For non-urgent administrative questions, you may also call or text (903) 509-0999, or email [email protected]. Please avoid including detailed clinical information in standard SMS or email.

For emergencies, call 911 or 988.

Patients may reach out with brief, time-sensitive questions between visits, recognizing that messaging is not a substitute for scheduled clinical visits. When concerns require more in-depth discussion, medication adjustments, or ongoing support, we will recommend scheduling a follow-up visit to ensure your care is addressed thoroughly and appropriately.