Key Takeaways

• A bookkeeper handles the day-to-day categorization of income and expenses
• An accountant can produce financial reports, file your taxes, and help with more complex financial admin
• CPAs and enrolled agents (EAs) have unlimited rights to represent you before the IRS in an audit or tax dispute; a bookkeeper or non-credentialed accountant generally does not

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Investing in professional help to manage the financial side of your therapy practice can have  a huge payoff. Not only do bookkeepers and accountants ensure you accurately track your finances and file your taxes, but they can free up time and energy to devote to your clients.

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There are four types of financial professionals to turn to when you need help: 

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• Bookkeepers
• Accountants
• Certified public accountants (CPAs) 
• Enrolled agents (EAs)

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Here’s what each one does, and how to choose (and hire) the right professional for your therapy practice.

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The four professionals at a glance

Here is a quick side-by-side comparison. Costs are averages or typical ranges and vary by location and the complexity of your practice, so treat them as a starting point and ask for a quote.

Bookkeeper vs. accountant vs. CPA vs. EA for therapy practices

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Accountant fees come from the 2023 NSA income and fees survey, and the bookkeeper range is a typical freelance rate. Each role is covered in detail below.

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CPA vs. EA: which one do you need?

CPAs and EAs both have unlimited practice rights before the IRS (along with attorneys), which means either one can represent you in an audit, collections matter, or appeal. The difference is focus. An EA is a federally licensed tax specialist. A CPA is licensed by your state and covers broader accounting and advisory work in addition to taxes.

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• Lean toward an EA if your main need is tax help: preparing your return every year, answering an IRS notice, handling an audit or collections issue, or advising on tax elections such as S corporation status.
• Lean toward a CPA if you also want broader financial guidance, such as financial statements for a lender, multi-state tax planning, budgeting, or planning for growth or a sale.
• Use both if your practice has complex tax and advisory needs, or look for a professional who holds both credentials.

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One more point: communications with a federally authorized tax practitioner (a CPA, an EA, or an attorney) about tax advice may be protected by a confidentiality privilege under IRC section 7525. It is not limited to EAs, and it applies only in noncriminal tax matters before the IRS or in federal court, so don’t treat it as a guarantee of confidentiality in every situation.

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Bookkeepers and your therapy practice

Bookkeepers track your day-to-day business transactions and prepare the information so you (or your accountant) can use it to file taxes. 

What a bookkeeper can do for your therapy practice

Every time your therapy practice spends or earns money, your bookkeeper makes a record of it. These records are kept in your general ledger, organized into different accounts (also called ledgers). 

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Your bookkeeper may prepare financial reports for your therapy practice, which you can use to make business decisions and file your taxes. In some cases, your bookkeeper may deliver your general ledger to your accountant, who then prepares your financial reports like your balance sheet and your profit and loss statement (P&L).

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By tracking your transactions and preparing reports, a bookkeeper gives you insight into how your therapy practice is running, and what steps you may need to take to keep it financially healthy.

Bookkeeper qualifications

Virtually anyone can start a bookkeeping business and advertise themselves as a bookkeeper. They don’t need a license or any other type of certification.

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However, for the sake of building trust, many bookkeepers opt to apply for a certified bookkeeping professional (CPB) or certified bookkeeper (CB) designation.

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The CPB designation is managed by the National Association of Certified Public Bookkeepers (NACPB), while the CB designation is managed by the American Institute of Public Bookkeepers (AIPB). To qualify for either, an individual must work as a bookkeeper for a minimum number of hours and pass a certification exam.

When to hire a bookkeeper

Many therapists handle their own bookkeeping early on, when there are relatively few income and expense transactions to record. In Heard’s 2026 Financial State of Private Practice Report, 33.5% of respondents said they do their own bookkeeping and taxes, while 18.4% outsource to an accountant or bookkeeper (n=1,630).

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A good rule of thumb is to bring in a bookkeeper once you reach a full caseload, roughly 20 to 25 clinical hours per week, and your practice becomes more complex. At that point, the benefits of professional bookkeeping typically begin to outweigh the cost. Other signs it’s time to hire a bookkeeper:

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• You continually fall behind or make bookkeeping errors (miscategorized transactions, misdated entries), and those errors make tax season more complicated
• You’re planning a major step up in practice size and complexity, such as hiring staff, moving to a new office, or partnering with other clinicians
• You plan to apply for a business loan or line of credit, which typically requires financial statements (a P&L and balance sheet)
• Financial admin and other back-office tasks put a limit on how many clients you can see per week

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For a deeper look, read should you do your own bookkeeping as a therapist?, when to hire a bookkeeper for your therapy practice, or our complete guide to bookkeeping for therapists.

How to work with a bookkeeper

In order to categorize your transactions—sorting them into different accounts—and record them in the general ledger, your bookkeeper needs information on how you use your money.

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• How much you spend, and when
• How much you earn, and when

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In the past, you’d provide this information in the form of a daybook, a kind of “rough draft” of accounts, where you’d write down information about each transaction. Today, the job is made much easier with software.

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Most bookkeepers use software to track their clients’ transactions. On the client end, you install the software and set it up to synchronize with your business checking and credit card accounts. 

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Transactions from those accounts are automatically imported into the app, and from there you can sync them with the general ledger managed by your bookkeeper. Your bookkeeper categorizes the transactions and enters them in your general ledger.

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Your bookkeeper may then use the information in your ledger to create monthly or quarterly financial reports, as well end-of-year reports, that summarize your financial activity. You can use this information to file your taxes.

How much does it cost to hire a bookkeeper?

Bookkeepers typically charge based on how many hours per month they need to spend working on your books. As a result, the more complex your therapy practice’s financials are, the more bookkeeping is likely to cost.

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For instance, if you only have half a dozen transactions per week—say, a few payments from clients, plus one or two bills or loan payments—the cost of bookkeeping may be relatively inexpensive. 

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On the other hand, if you have twenty-five transactions per week—money coming in from clients, plus expenses related to running an office and paying employees—your bookkeeping will cost you more.

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Freelance bookkeepers typically charge $25–$60 per hour. For a practice with real transaction volume, that often works out to roughly $300–$1,500 per month, depending on how many transactions you have and how much cleanup or reporting you need.

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For context, the median therapist in Heard’s 2026 Financial State of Private Practice Report spent $1,107 per year on accounting, bookkeeping, and tax filing combined (median, n=1,670). That figure includes therapists who handle some or all of this themselves, so think of it as a baseline rather than a price quote.

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When you work with Heard, you pay a flat monthly rate for bookkeeping and accounting services.

How to hire a bookkeeper for your therapy practice

When hiring a bookkeeper for your therapy practice, you can turn either to an individual freelancer or a firm.

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Freelance bookkeepers

Freelancers have a wide range of levels of experience. Thanks to accounting software and online freelancing sites like Upwork, it’s possible to hire a bookkeeper just about anywhere in the world. You can also likely find a freelancer in your own community who is up to the task. 

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Before hiring a freelance bookkeeper, find out whether they’ve worked with therapy practices in the past; if they’re already familiar with how a therapy practice operates, it may take them less time to set up your chart of accounts and get the hang of how your transactions should be categorized.

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Bookkeeping firms 

In contrast to single-bookkeeper freelance operations, larger bookkeeping and accounting firms may employ many bookkeepers, all of which typically need to meet certain minimum requirements to work there. A large bookkeeping firm may cost less than a local freelancer, but they may not have industry-specific experience when it comes to therapy practices.

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Heard exclusively works with therapists who run their own practices.

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Accountants and your therapy practice

Accountants help you file taxes and make major business decisions based on data compiled by your bookkeeper. Not sure where a bookkeeper’s job ends and an accountant’s begins? Read what’s the difference between an accountant and a bookkeeper.

What an accountant can do for your therapy practice

When you hire an accountant for your therapy practice, they can:

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• Prepare and file your tax return for you. Some small business owners consult with their accountant throughout the year for business advice. Others only see them during tax season, when it’s time to file. 
• Provide guidance and advice. Your accountant can help you identify ways to save money—for instance, by identifying and reporting deductible expenses, or by helping you choose a business structure. They can advise you on tasks like setting up payroll or applying for business loans and lines of credit.
• Plan for the future. An accountant can help you build and balance a budget for your therapy practice, create financial projections, and plan for growth.

Accountant qualifications

In order to work as an accountant, an individual needs, at minimum, a bachelor’s degree in accounting. 

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A bachelor’s degree provides an accountant with the fundamentals they need to handle accounting tasks for individuals and businesses, while complying with Generally Accepted Accounting Principles (GAAP).

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Many accountants seek additional certifications. The most common certifications for accountants are:

• Certified Public Accountant (CPA)
• Enrolled Agent (EA)
• Certified Internal Auditor (CIA)
• Chartered Financial Analyst (CFA)
• Certified Fraud Examiner (CFE)
• Certified Management Accountant (CMA)

Two of these—CPAs and EAs—are covered below.

When to hire an accountant for your therapy practice

Your therapy practice can benefit from working with an accountant at every stage of growth:

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• New practices (solo, part-time): For tax filing, taking advantage of tax-deductible expenses, and planning for growth. A sole proprietor’s return typically runs a few hundred dollars (about $279 non-itemized or $392 itemized, on average).
• Later-stage practices (solo, full-time): As well as filing taxes and helping with deductions, an accountant can advise you on whether to form an LLC or PLLC and whether to elect S corporation status. Forming the entity itself is a state filing, and once you incorporate, your annual tax return typically costs closer to $1,000.
• Established, large practices (multiple clinicians): An accountant can help you set up payroll and manage the more complex financial admin that comes with having multiple clinicians on staff.

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Even if you’re at the stage where you do your own bookkeeping, help from an accountant is a valuable asset. Tax filing errors can be costly, so it’s best to file with professional support. Still weighing it up? Here are 7 reasons to hire an accountant for your therapy practice.

How to work with an accountant

How you end up working with an accountant depends upon the needs of your therapy practice.

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If you’re the only person working at your therapy practice, your accounting needs may be straightforward. In that case, you may only meet with your accountant at tax time to have them file your taxes for you.

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On the other hand, if you have employees or contractors, or you share ownership of your practice with other therapists, you may employ an accountant on an ongoing basis. They can generate financial statements for you and help analyze them, so you can track your business’s many different moving parts.

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Finally, you may hire an accountant to guide you through a particular challenge. Many small business owners hire accountants to help them incorporate their company, prepare it for sale, bring on partners, or apply for business loans and lines of credit.

How much does it cost to hire an accountant?

How much you pay for an accountant depends upon the needs of your business.

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For instance, a sole proprietor with a non-itemized tax return could expect to pay something like $279 to have their taxes filed, while an itemized tax return for the same sole proprietor would cost $392 (on average). As soon as that sole proprietor incorporates, their annual tax return starts costing closer to $1,000.

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You can find a full breakdown of average accounting fees in the 2023 NSA income and fees survey.

How to hire an accountant for your therapy practice

Similarly to working with a bookkeeper, you may hire an accountant who is self-employed or one who is an employee at an accounting firm.

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Large accounting firms like H&R Block provide one-stop accounting services at tax time for small businesses. It’s a popular choice for many small business owners or individuals who need help filing their taxes. 

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However, accountants at large firms aren’t guaranteed to have experience serving therapy practices, and may not be familiar with certain tax deductions—such as the cost of HIPAA-compliant software and payment processors, or therapeutic tools—common for therapists.

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Other accountants are self-employed, working as individual freelancers or sharing their firm as partners with other accountants. They may be able to provide more personalized services than a large accounting firm, and may have experience working with therapy practices. They’re a better choice if you want to build a long-term relationship with your accountant.

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The tradeoff is that hiring a smaller firm or individual may cost more than working with a one-stop accounting service like H&R Block. 

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Heard handles bookkeeping, accounting, and taxes exclusively for therapy practices for one flat monthly rate.

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Certified Public Accountants (CPAs) and your therapy practice

A CPA is an accountant who has achieved an extra level of certification with accounting authorities in your state; all CPAs are accountants, but not all accountants are CPAs.

What a CPA can do for your therapy practice

A CPA can perform any task typically handled by a non-CPA accountant, including generating and analyzing financial reports and preparing your taxes.

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Importantly, CPAs have unlimited practice rights before the IRS (under Treasury Department Circular 230), as do enrolled agents and attorneys. That means a CPA can represent you in dealings with the IRS, such as an audit, negotiating lower tax penalties, or amending past tax returns. A CPA can also prepare the financial statements (a P&L and balance sheet) that lenders typically ask for when considering your application for a loan. 

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According to the 2023 NSA income and fees survey, 36% of respondents were CPAs.

When to hire a CPA

When it’s time to hire an accountant, even for simple, early-stage tax filing, you may benefit from working with a CPA from the get-go. In the event of an audit or tax dispute with the IRS, a CPA can serve as your representative, and hiring a CPA early on helps protect you from problems that may arise later.

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If you don’t already have one, consider hiring a CPA when:

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• You’re facing an IRS audit or tax dispute (a CPA or an EA can represent you; see 7 ways your therapy practice can avoid an IRS audit)
• You’re applying for a business loan or line of credit and need financial statements
• You’re deciding whether to form an LLC or elect S corp status (a CPA can advise on the tax side, though forming the LLC itself is a state filing)
• You bring on staff or partner with other clinicians (payroll doesn’t require a CPA, but a CPA can help you plan for it)
• You expand your practice to serve clients in multiple states

CPA qualifications

A CPA is licensed by the Board of Accountancy in the state where they operate. In order to become licensed as a CPA, an accountant generally must meet the following requirements, which vary by state:

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• Education: A bachelor’s degree or higher in accounting, finance, or business administration. Most states require 150 semester hours of education (including 24 semester hours in accounting), and a growing number now offer a 120-hour pathway plus experience. Check your state board.
• Experience: Typically one to two years working under a licensed CPA (the 120-hour pathway generally requires two). Requirements vary by state, so check with your state board.
• Examination: To become a CPA, an accountant must pass the Uniform CPA Exam.

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In addition, a CPA is required to pursue continuing education in regulatory review and ethics.

How to work with a CPA

Working with a CPA is identical to working with an accountant—a CPA is simply an accountant with an added designation. 

How much does it cost to hire a CPA?

For the most part, you can expect the cost of hiring a CPA to be within the same range of hiring an individual, non-CPA accountant. Fees vary by location and the work involved, so ask for a quote based on whether you need tax preparation, advisory help, or both. 

How to hire a CPA for your therapy practice

Hiring a CPA is identical to hiring an accountant—a CPA is simply an accountant with an added designation.

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Enrolled Agents (EAs) and your therapy practice

What is an enrolled agent (EA)?

An enrolled agent (EA), sometimes called an EA accountant, is a federally licensed tax practitioner who is enrolled with the IRS and has unlimited rights to represent individuals and businesses before it. Their work is focused almost entirely on taxes rather than day-to-day accounting.

What an EA can do for your therapy practice

An EA is federally authorized to help any individual or business with anything to do with their taxes, and to represent them before the IRS on any matter, including audits, collections, and appeals. Communications with an EA about tax advice may also be covered by the federal tax practitioner confidentiality privilege. That privilege is not unique to EAs (it also applies to CPAs and attorneys), and it is limited to noncriminal tax matters.

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An enrolled agent can help your therapy practice:

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• Navigate complex tax laws
• Represent you in dealings with the IRS
• Prepare, sign, and file your tax return
• Help you plan how you’ll file and pay your taxes
• Assist you with any other tax-related tasks

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An EA is not the best professional to hire if you need help with other accounting matters—such as financial statements, planning to sell your practice or bring on investors, or building a budget. For that, you’re better off talking to a CPA. For tax questions, though, including tax elections like S corporation status, an EA is fully qualified to advise.

When to hire an EA for your practice

Because EAs specialize in taxes, they’re a good fit when your main need is tax help, especially when the IRS is involved. Consider hiring an EA when:

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• You receive an IRS notice or letter you don’t understand, or one that proposes changes to your return
• You’re facing an IRS audit or examination
• You owe back taxes or you’re dealing with IRS collections, for example setting up a payment plan
• You want a tax specialist to prepare your return every year, particularly if your situation is more complicated, such as an S corp or income in more than one state

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In an audit or tax dispute, an EA and a CPA are equally authorized to represent you before the IRS. The better choice often comes down to whether you also want broader accounting and advisory help (a CPA) or a tax-only specialist (an EA).

EA qualifications

EAs are licensed at the federal level, not the state level (as with CPAs).

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In the words of the National Association of Enrolled Agents (NAEA):

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Only enrolled agents are required to demonstrate to the IRS their competence in all areas of taxation, representation and ethics before they are awarded unlimited representation rights to represent taxpayers before the IRS.

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To become an EA, a person must either:

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1. Pass all three parts of the Special Enrollment Examination (SEE) and a suitability check, then complete continuing education to maintain their enrollment (72 hours every three years).
2. Have at least five years of qualifying experience at the IRS (in a role such as revenue agent, revenue officer, or appeals officer), in which case they may be exempt from the SEE. They must apply within three years of leaving the IRS.

How to work with an EA

Business owners typically hire EAs when they need help filing their taxes or when they’re seeking someone to represent them in dealings with the IRS. If you’re resolving a specific IRS issue, the relationship is typically short-term and ends once the issue is resolved. If you hire an EA as your annual tax preparer, you may work with them year after year.

How much does it cost to hire an EA?

EA fees vary by location and by the work involved, so there’s no single going rate. Preparing a tax return is usually quoted per return (the average fees in the 2023 NSA income and fees survey came from a pool of preparers in which 49% of respondents were EAs and 36% were CPAs), while IRS representation work, such as an audit or collections case, depends on how much time your case is expected to take. Before hiring an enrolled agent, ask for a written quote based on the work they expect it will take to handle your case.

How to hire an EA for your therapy practice

To hire an enrolled agent, visit the NAEA’s online directory.

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The IRS recommends you check with the Better Business Bureau (BBB) before hiring an enrolled agent. If you’re unsure whether an EA is qualified, you can email their full name, address (if available), and EA number (if available) to epp@irs.gov for confirmation.

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Learn more about how to hire an accountant for your therapy practice.

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Summary

• Once your practice reaches a full caseload (about 20–25 clinical hours per week), hiring a bookkeeper frees up time in your schedule and makes tax season easier
• Your practice benefits from working with an accountant from the get-go, since they can help ensure accurate, hassle-free tax filing
• Consider a CPA when you need broader advice on things like entity structure and S corp election, multi-state taxes, or a growing payroll (LLC registration itself is a state filing)
• CPAs and EAs both have unlimited rights to represent you before the IRS, and an EA is a tax specialist who is fully qualified to advise on tax matters like S corp election
• A CPA is a strong all-around choice for many full-time and multi-clinician practices, but if your needs are mostly tax-focused, an EA or experienced accountant may serve you just as well

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This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this post.

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Bryce Warnes is a West Coast writer specializing in small business finances.

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