Name Change and Replacement/Duplicate License Requests

Pursuant to A.R.S. § 32-4225(C), "Each licensee is responsible for reporting to the Board a name change and changes in business and home address and phone numbers within ten (10) after any change" (emphasis added). Please use the "Name Change Form" link to complete and submit your name change and supporting documentation:

ONLINE NAME CHANGE-    Online name change

NAME CHANGE-    Download PDF

Please use the "Duplicate License Form" link to request a new wall certificate or a wallet license due to a name change, or if you are requesting multiple wall certificates for multiple offices or to replace a lost or misplaced license.

DUPLICATE LICENSE - 

After payment, you get Authorization Code # to place on Form. 

DUPLICATE LICENSE PAYMENT - $27.50 Online Payment

ONLINE DUPLICATE LICENSE  -    Online Duplicate

 DUPLICATE LICENSE-    Download PDF

Complete with a pen and mail to the Board.

U.S. Postal Address
Arizona State Board of Massage Therapy
1740 W. Adams, St., S. 3401
Phoenix, Arizona 85007

PLEASE NOTE: All fees are non-refundable, pursuant to A.A.C. R4-15-102.