1/21/2018

CREATE NEW ESERVICES USER ACCOUNT
  • This information is strictly confidential and Department of Professional Licensing uses Secured Sockets Layer (SSL) and 128-bit encryption for online data transmissions.
  • If you opt to use the OP ID and have not received correspondence with your OP ID number, please contact the Department of Professional Licensing at (502) 564-3296.
  • Username:
    (Must be between 8-15 alpha numeric characters in length)
    Password:
    (Must be between 8-15 alpha numeric characters in length, should have at least 1 number)
    Verify Password:
    (Must be between 8-15 alpha numeric characters in length, should have at least 1 number)
    User Type:
    (Select the appropriate type of user from the list)
    Security Question:
    Answer:
    First Name:
    Middle Name / Initial:
    Last Name:
    Suffix Name:
    Phone Number:
    Ext:
    SSN or OP ID
    Email:
    (include the .com, .net or .org - accounts with invalid e-mail addresses will be removed)

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