Almost everything written about naturopathy opens with a number: how many states license naturopathic doctors. It is the wrong place to start, because the number is contested, nobody official publishes it, and even when it is right it does not answer the question a patient has, which is what this person was trained to do.
There is a better document, and it is public. The national licensing examination for naturopathic doctors publishes a study guide describing exactly what it tests and how heavily. The current edition was revised in March 2026 for that August’s administration.
Read it and two things jump out. Homeopathy is a scored subject on the core examination, sitting inside an area worth 18 to 20 percent of the whole. And pharmacology appears twice: as half of one 20 percent area on the core exam, and again as a separate elective examination.
What an elective means in practice is set out in a footnote. The examination board’s jurisdiction table marks each jurisdiction’s requirements with one of two symbols, and to one of those symbols it attaches this: “You are required to take the examination only if you wish to use this modality in your practice.” On the pharmacology row, at least one jurisdiction carries that symbol. The table’s other symbol appears on the same row, the document defines it nowhere, and so this article does not say which state is which. What the table does establish is that in at least one of the 25 US jurisdictions it lists, the pharmacology examination is one a candidate sits only if they plan to use the modality.
Inside the 400-question examination
The core clinical science examination has 400 multiple-choice questions, divided into four general exam areas.
Diagnosis carries 30 to 35 percent and covers physical and clinical diagnosis plus laboratory and imaging diagnosis. Materia medica carries 18 to 20 percent and contains two subjects: botanical medicine and homeopathy. Other modalities carries 28 to 30 percent and covers nutrition, physical medicine and psychology. Medical interventions carries 20 percent and covers emergency medicine and pharmacology.
A small wrinkle is worth noting because it shows how precise these documents really are. The guide’s competencies section gives slightly different ranges from its passing standards section, listing diagnosis at 34 to 35 percent and materia medica at 19 to 20. The figures above come from the passing standards. The gap is small, it sits inside one document, and this article reports it rather than picking the tidier number.
Four elective examinations exist, at 75 questions each: minor surgery, pharmacology, acupuncture and parenteral medicine. The guide describes these as assessing minimal competence in areas the core exam may not address.
Now put the pieces together. Diagnosis is weighted heaviest, which fits a profession that works in primary care settings in some states. Homeopathy is scored, and this library’s article on homeopathy handles what the evidence on that practice shows. Pharmacology occupies roughly a tenth of the core exam and a whole separate optional test. Those three facts, from one public document, describe the scope-of-practice argument better than anyone’s opinion about it.
The license count, and where it comes from
Here is how to report a number responsibly when no federal agency publishes it, and no federal agency publishes this one.
Wyoming’s Legislative Service Office issued a research memo in July 2025, written by research analyst Clayton Caldwell, stating that at least 23 states and Washington, D.C. regulate naturopathic doctors. The hedge is in the original and should stay in. Its appendix names them: Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington and Wisconsin, plus the District.
Connecticut’s Office of Legislative Research reached the same tally on October 4, 2023, in a report by principal analyst Nicole Dube, and it did something the Wyoming memo did not: it named its source. The count comes from the American Association of Naturopathic Physicians, as of June 2023. A state legislature’s research office, which is about as neutral a source as this subject has, is repeating a figure produced by the profession’s own trade association.
The examination board’s jurisdiction table, revised September 2025, lists the same 23 states plus the District of Columbia and Puerto Rico. It also carries a line that every writer who cites it should carry too: “NABNE cannot guarantee that the information below is accurate.”
So the honest form of the sentence is long, and it has to be. As of July 2025, a state legislative research office reported that at least 23 states and the District of Columbia regulate naturopathic doctors, and named them. Three sources converge. One of them disclaims its own accuracy, another traces the figure to an advocacy body, and no federal agency compiles the series at all.
The Connecticut report also demolishes the usual binary. Of the 23, sixteen require a license to practice, a figure the report credits to the American Naturopathic Certification Board rather than to the association behind the 23. The other seven offer licensure or registration without requiring it, which means that in seven supposed licensing states, an unlicensed person may still practice. Three states, Florida, South Carolina and Tennessee, ban the practice of naturopathy outright. In the remaining states there is no licensure at all, so the word carries no legal content and no training requirement. That is at least five situations, not two, and which one you are in changes everything about what a title means.
Even within the licensing states the titles diverge. The Wyoming memo found that nine states plus the District allow the term “naturopathic physician,” while fourteen do not, and that Alaska bars the word “physician” in such a practitioner’s title entirely. Two other articles here cover the general lessons: how to read the letters after a practitioner’s name, and the limits of what any state license guarantees.
What a licensed naturopathic doctor may prescribe
Prescriptive authority is where the exam and the statute books meet, and the Connecticut report counted it.
Of the states that license or register naturopaths, it found fifteen that grant some form of prescriptive authority. Eight of those, Arizona, California, New Hampshire, New Mexico, Oregon, Utah, Vermont and Washington, allow limited controlled substances. Maryland and Rhode Island make a written collaborative agreement with a licensed physician a condition of licensure. Colorado asks less: only an attempt at one, and only when the practitioner is treating a child up to age eight who has a relationship with a licensed pediatrician. Connecticut itself grants no prescriptive authority.
Hold that against the examination. In at least one jurisdiction the board’s table marks the pharmacology examination as one a candidate takes only if they intend to use the modality. The scope a state grants and the examinations a candidate sat are two different things, and a patient looking at a wall of certificates cannot see the second one.
The schools are contracting right now
Program accreditation for naturopathic medicine runs through the Council on Naturopathic Medical Education, and its own list is more informative than anything written about it.
First, a distinction that trips up nearly every account. That council accredits the program. A separate institutional accreditor, recognized by the U.S. Department of Education, accredits the school. Conflating the two produces claims of federal recognition that the documents do not support. This article tried to confirm the council’s recognition status directly in the Department’s accreditation database and could not reach it, so what follows is what the available sources say and no more.
Six programs currently appear on the council’s accredited list: Bastyr University in Kenmore, Washington and San Diego, California; the Canadian College of Naturopathic Medicine in Toronto and New Westminster; National University of Health Sciences in Lombard, Illinois; National University of Natural Medicine in Portland, Oregon; Sonoran University of Health Sciences in Tempe, Arizona; and Universidad Ana G. Méndez in Gurabo, Puerto Rico. One of the six is in Canada and one is in a U.S. territory.
The oldest and largest is in trouble, and the chronology is public. Bastyr University, first accredited in April 1987, was placed on probation on October 31, 2024. On May 16, 2025, the council replaced that probation with a show cause sanction. At its May 8, 2026 meeting the council reaffirmed the program’s accreditation for three years, removed the show cause sanction and imposed probation, citing non-compliance in five areas including the adequacy and stability of financial resources, strategic and financial planning, faculty retention and monitoring of board exam pass rates. A progress report on financial stabilization was due October 1, 2026 and a focused report is due March 1, 2027.
The pipeline shrank too. University of Western States in Portland was granted candidate status in April 2025 and the university announced in May 2026 that it was discontinuing the program, with the council removing it from candidacy. University of Bridgeport’s naturopathic program graduated its final class in May 2022.
That last fact produces a conflict between two authoritative sources that a reader should know about. The Council for Higher Education Accreditation still lists University of Bridgeport in its directory entry for the naturopathic accreditor, and still marks the Puerto Rico program as a candidate when the accreditor’s own list shows it fully accredited since January 2021 and reaffirmed in May 2024. The cause is not a disagreement. The directory entry carries its own currency note saying its program list reflects accreditation as of October 2019. Both pages are authoritative. One is seven years stale and says so in small print.
The person who cannot be licensed at all
The federal consumer page on naturopathy, last updated in April 2025, draws the distinction that matters most and does it in one line. Licensed naturopathic physicians complete graduate-level education at an accredited naturopathic medical school, typically a four-year program, and must pass national board examinations where licensure exists. Traditional naturopaths may train through non-accredited programs of varying length and content, and the page states plainly that they are not eligible for licensing.
Put that beside the state picture and the practical consequence is sharp. In the states with no licensure, there is no barrier to using the word. A person with a correspondence certificate and a person with a four-year accredited degree may use the same noun in the same sentence on the same street, and neither has broken any rule.
The profession’s own account of itself comes from the American Association of Naturopathic Physicians, whose house of delegates position paper, amended in 2011, names six principles. The first is the healing power of nature, given in Latin as vis medicatrix naturae, which the association describes as an inherent, orderly self-healing ability that the practitioner works to support by removing obstacles. The others are identifying and treating causes, first doing no harm, doctor as teacher, treating the whole person and prevention. Those six principles are the profession’s self-description, and they are reproduced here as that and nothing more.
Something notable happens when that framework meets the federal page. Neither the phrase “healing power of nature” nor “vital force” appears anywhere on it. A second finding is larger: the page contains no summary of what the research shows about whether naturopathy works. It describes practitioner types, training and usage, lists references, points readers to database searches, and never states a conclusion. The federal agency for research into complementary health publishes a consumer page on naturopathy that does not tell a consumer whether it works.
Where does the evidence sit, then? For naturopathy as a whole system, there is insufficient evidence to assess, and the reason is that almost nobody has tried to test the package rather than its parts. Individual components, from nutrition counselling to botanical products, have their own literatures of wildly differing quality, and this library grades them in their own articles.
Vaccination, read from both primary records
This subject is usually argued from each camp’s press releases. Two primary documents do better.
The measured record first. A study in Maternal and Child Health Journal in 2010 analyzed insurance claims for children covered by two Washington State insurers between 2000 and 2003. Children were significantly less likely to receive each of four recommended vaccinations if they saw a naturopathic physician, and children aged one to seventeen were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Chiropractic care was associated with three of the four vaccinations. Use of these providers by other family members showed no independent association with either outcome, a specificity check that strengthens the finding.
That is an association in claims data, not a trial, and claims data cannot tell you what was said in the room. The same research group, publishing in 2009, found the picture is not uniformly negative: naturopathy use was associated with lower mammography rates, while all four complementary therapies studied were associated with higher rates of cervical cancer screening. The authors called the mammography association something requiring further study.
The position statement second. The Naturopathic Academy of Primary Care Physicians publishes a position paper on immunizations, undated, which this article read on a copy hosted by the Washington State Department of Health. It states that the academy takes a clear pro-immunization position, recommends that naturopathic physicians know, understand and follow the immunization guidelines appropriate for the individual patient, and refers to the federal childhood and catch-up schedules.
The same paper also says it would be preferable to follow an alternative schedule rather than avoid immunizing altogether. Both halves are in the document. A reader who sees only the first half thinks the question is settled, and a reader who sees only the second thinks the position is a pose. Neither reading survives the document.
The loudest outside voice belongs to the American Academy of Family Physicians. Its policy on naturopathic practice, carrying a December 2019 page date and congress of delegates action in 2012 and again in September 2022, opposes licensure of naturopaths outright. It states that their education does not prepare them to diagnose or treat appropriately. It says a naturopath must never be allowed to use the title physician, or be considered a primary care physician.
That is one professional body’s position on another profession’s licensure. It is reported here as such, not adopted.
A death, and a regulatory record in the wrong country
In August 2017 the Food and Drug Administration announced an investigation into two serious adverse events involving a compounded intravenous curcumin product. A 30-year-old woman went into cardiac arrest within minutes of an infusion, suffered brain injury from lack of oxygen and died; local authorities identified a reaction to the infused solution as a cause of death. FDA states she was being treated for eczema by a naturopathic doctor. A 71-year-old man developed a hypersensitivity reaction after the same type of product and was treated and released from an emergency room; FDA states he was being treated for thrombocytopenia at a holistic health center.
The implicated ingredient was PEG 40 castor oil used in compounding, which the agency reported was ungraded, neither pharmaceutical nor food grade, and in which it found 1.25 percent diethylene glycol. FDA does not name who administered either infusion, and nobody should imply that it does.
The practice restriction this article could find came from British Columbia. A notice published by the province’s naturopathic regulator records that in May 2017 the college placed a moratorium on starting any new patients on intravenous curcumin as a temporary measure pending further research, and that the board lifted that moratorium effective June 5, 2024. The death was in the United States. The regulatory document was Canadian. No equivalent American state board document surfaced here, which is not the same as establishing that none exists, since this article did not search every state board’s disciplinary database.
What to ask, and the one thing worth remembering
Nothing in this article tells you to see or avoid any practitioner, or to start, stop or delay anything. Any of that is settled between a patient and a clinician with the full history in front of them. What this article can offer is a short list of questions whose answers are checkable.
- Which state licenses this person, and does that state require a license or merely offer one? Those are different, and in seven states the difference is real.
- Was the degree earned at a program on the accreditor’s current list, which has six entries, or at some other school? Accredited is a status with a date, not an adjective.
- Did this practitioner sit the pharmacology elective? In at least one jurisdiction the board’s own table makes it conditional on intending to use the modality, and the answer bears directly on what they should be advising about your prescriptions.
- Is the plan being offered in addition to care you already have, or instead of it?
Some circumstances need a conventional clinical assessment quickly, whoever else is involved: a child who is getting worse rather than better, a new lump, chest pain, unexplained bleeding or weight loss, a diagnosed condition where you are being advised to stop an existing medication, or any proposal to put a substance into a vein outside a hospital. The documented death above involved an intravenous infusion of a compounded product for a skin condition.
The most useful thing to carry out of all this is not the state count. It is that this field keeps its hardest questions in public documents that almost nobody opens. The examination weights, the probation notices, the dated jurisdiction table with its own accuracy disclaimer and the profession’s own position papers are all free to read. The argument about naturopathy is noisy. The record is quiet, specific and sitting there.
Sources
- NPLEX, Inc. and the North American Board of Naturopathic Examiners. “NPLEX Part II Clinical Sciences Study Guide, revised March 2026 (400-question Core Clinical Science Examination; general exam areas and weightings; four 75-question elective examinations).”
- North American Board of Naturopathic Examiners. “State and Provincial Requirements, revised September 2025 (25 US jurisdictions listed; elective examination rule; accuracy disclaimer).”
- Wyoming Legislative Service Office, Research and Evaluation Division. “Naturopathic Doctor Title Requirements by State, by Research Analyst Clayton Caldwell (July 2025).” wyoleg.gov
- Connecticut General Assembly, Office of Legislative Research. “Naturopath Licensing and Prescriptive Authority in Other States, Report 2023-R-0240, by Principal Analyst Nicole Dube (October 4, 2023).” prdext3.cga.ct.gov
- Council on Naturopathic Medical Education. “Accredited Naturopathic Schools (current accreditation actions, including the Bastyr University probation imposed at the May 8, 2026 meeting and the removal of University of Western States from candidate status).” cnme.org
- Council for Higher Education Accreditation. “Council on Naturopathic Medical Education directory entry (recognition and programme list, with a currency note stating programmes were accredited as of October 2019).” chea.org
- National Center for Complementary and Integrative Health, National Institutes of Health. “Naturopathy (content last updated April 2025; licensed naturopathic physicians, traditional naturopaths and eligibility for licensing).” nccih.nih.gov
- American Association of Naturopathic Physicians. “Principles of Naturopathic Medicine (House of Delegates position paper, amended 2011).” naturopathic.org
- American Academy of Family Physicians. “Naturopathic Practice (policy; page dated December 13, 2019, with 2012 and September 2022 Congress of Delegates actions).” aafp.org
- Naturopathic Academy of Primary Care Physicians (document hosted by the Washington State Department of Health). “Position Paper on Immunizations (undated).” doh.wa.gov
- U.S. Food and Drug Administration. “FDA investigates two serious adverse events associated with ImprimisRx's compounded curcumin emulsion (August 4, 2017).”
- College of Complementary Health Professionals of British Columbia (legacy College of Naturopathic Physicians of British Columbia). “Re: Update – IV Curcumin (May 2017 moratorium; lifted effective June 5, 2024).”
- Downey L, Tyree PT, Huebner CE, Lafferty WE. “Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers. Matern Child Health J, 2010;14(6):922-30. PubMed. DOI: 10.1007/s10995-009-0519-5.” pubmed.ncbi.nlm.nih.gov
- Downey L, Tyree PT, Lafferty WE. “Preventive screening of women who use complementary and alternative medicine providers. J Womens Health (Larchmt), 2009;18(8):1133-43. PubMed. DOI: 10.1089/jwh.2008.1230.” pubmed.ncbi.nlm.nih.gov