TheraNest (Ensora Mental Health) EHR Review (2026)

Overview

TheraNest -- now branded as Ensora Mental Health -- is a cloud-based practice management and EHR platform designed for outpatient mental health therapists, counselors, and small behavioral health practices. Founded in 2013 in Birmingham, Alabama by Shegun Otulana, TheraNest grew into one of the most widely used practice management tools in the therapy space, competing directly with SimplePractice and TherapyNotes for the hearts and wallets of private practice clinicians.

The platform covers the core workflow loop that outpatient therapists need: scheduling, clinical documentation, insurance billing with clearinghouse integration, telehealth, e-prescribing, a client portal, and -- more recently -- an AI-powered session documentation tool. With over 200,000 providers on the broader Ensora Health platform, it has significant scale in the mental health EHR market.

The elephant in the room is ownership. In May 2021, KKR acquired Therapy Brands -- the parent company of TheraNest and several other behavioral health software products -- for $1.25 billion. In April 2025, Therapy Brands rebranded to Ensora Health, and TheraNest became Ensora Mental Health. This is not merely a cosmetic name change. The private equity acquisition has meaningfully altered the product trajectory, support quality, and business practices in ways that prospective buyers need to understand.

This review evaluates TheraNest on the strength of its product foundation while being transparent about the operational changes under KKR ownership. The core product remains capable. Whether the ownership structure introduces acceptable risk depends on your practice's priorities and tolerance for the patterns that typically follow PE acquisition of healthcare software companies.

Disclosure: EHR Source is an independent review site with no business relationship with Ensora Health, TheraNest, or any vendor listed on this site. Our reviews are based on publicly available information, user feedback, and hands-on evaluation.

Key Features

Practice Management and Scheduling

TheraNest's scheduling system is built around a calendar-centric workflow that handles individual and group appointments, recurring sessions, automated appointment reminders (email and SMS), and a waitlist. The calendar supports multiple provider views, making it functional for group practices where front-desk staff need to manage several clinicians' schedules simultaneously. Online booking allows clients to self-schedule through the client portal, reducing phone call volume and no-shows.

The scheduling module integrates directly with the billing workflow -- completed sessions can be converted to claims with minimal manual data entry. For practices where scheduling, documentation, and billing are handled by the same person (which describes most solo and small practices), this tight integration eliminates context-switching between separate systems.

Clinical Documentation

TheraNest provides structured progress note templates including DAP (Data, Assessment, Plan) and SOAP formats, treatment plan templates, intake assessments, and discharge summaries. The custom dynamic forms builder allows practices to create their own intake forms, questionnaires, and assessment tools without needing vendor professional services. Custom forms can be assigned to the client portal for completion before appointments, streamlining the intake process.

Documentation supports electronic signatures with audit trails, co-signing workflows for supervised clinicians, and the ability to lock notes after a configurable review period. For group practices with interns or associate-level therapists, the co-signing capability is essential for maintaining compliance with supervision requirements.

AI Session Assistant

Available on the Premier plan, the AI Session Assistant is TheraNest's answer to the AI documentation wave sweeping the EHR market. The tool listens to therapy sessions (with explicit client consent) and generates progress notes automatically. Ensora claims a 90% reduction in documentation time, though independent verification of that figure is limited.

The AI Session Assistant produces structured clinical notes that therapists review and edit before finalizing. This is conceptually similar to AI scribe products from competitors and standalone tools like Freed and Upheal, but with the advantage of being natively integrated into TheraNest's documentation workflow. The generated notes feed directly into the chart without requiring copy-paste between systems. This feature is only available on the Premier tier ($89/therapist/month), which means practices on the Essentials or Advanced plans either pay up or look to third-party AI scribe integrations.

Wiley Practice Planners Integration

The Premier plan includes access to Wiley Practice Planners -- a well-known library of evidence-based treatment plan objectives, interventions, and diagnostic descriptions. For therapists who want structured, clinically validated language for treatment plans, this integration saves significant time compared to writing treatment plan content from scratch. This is a feature that TherapyNotes also offers, and it remains a meaningful differentiator against competitors that lack it.

Insurance Billing and Claims

TheraNest includes electronic claims submission through a clearinghouse integration, a claims manager for tracking submission status, ERA/EOB posting for automated payment reconciliation, batch claim submission, and a billing dashboard for aging analysis. The platform handles both primary and secondary insurance claims and supports superbill generation for clients who submit their own out-of-network claims.

It is important to note that under KKR ownership, TheraNest introduced Therapy Pay -- a Stripe-based payment processing system -- as the required payment processor for the platform. This forced migration away from previous payment processing options has been a significant source of user complaints (see Cons section).

Telehealth

TheraNest offers HIPAA-compliant video telehealth integrated into the scheduling and documentation workflow. On the Premier plan ($89/therapist/month), telehealth is included at no additional cost. On the Essentials and Advanced plans, telehealth is available as a $12/month add-on per therapist. Sessions launch directly from the calendar, and documentation is linked to the video encounter automatically.

The telehealth implementation is functional but not best-in-class. Practices that conduct a high volume of telehealth sessions and need advanced features like virtual waiting rooms, screen sharing, or group video should compare the experience against SimplePractice and dedicated telehealth platforms.

E-Prescribing with EPCS

TheraNest supports electronic prescribing including EPCS (Electronic Prescribing of Controlled Substances) for psychiatric prescribers and nurse practitioners. This includes drug interaction checking, allergy alerts, pharmacy routing, and a medication history view. For practices with prescribing clinicians, having e-prescribing natively in the EHR avoids the need for a standalone prescribing tool. This feature positions TheraNest closer to Valant in terms of prescriber support, though Valant's PDMP integration remains more mature.

Client Portal

The client portal provides a self-service interface for clients to complete intake paperwork, sign consent forms, view upcoming appointments, make payments, and communicate with their therapist through secure messaging. The portal supports custom forms created in the dynamic forms builder, so practices can push any documentation -- intake questionnaires, PHQ-9 screenings, consent forms -- to clients for completion before their first session.

Reporting

Built-in reports cover practice financial metrics (revenue by provider, aging accounts receivable, payment summaries), appointment statistics (no-show rates, utilization), and clinical data exports. The reporting module is adequate for solo and small practice needs but lacks the depth of analytics found in platforms targeting larger organizations. Practices that need advanced business intelligence or clinical outcomes reporting will likely need to supplement with external tools.

Pros

Cons

Pricing

TheraNest uses per-therapist, per-month pricing across three tiers. Unlike many behavioral health EHRs that hide behind "request a quote" walls, TheraNest publishes its pricing -- which is a genuine advantage during vendor evaluation. However, the shift from the original per-client pricing model to per-therapist pricing has increased costs for some existing users, particularly group practices that previously benefited from the old model.

Pricing comparison context: At $29/therapist/month, TheraNest's Essentials tier undercuts SimplePractice ($49+/month) and TherapyNotes ($69+/month) at the entry level. However, once you add telehealth ($12/month) and move to the Advanced tier for insurance billing, the price gap narrows considerably. At the Premier tier ($89/therapist/month), TheraNest is priced in the same range as competitors' premium plans -- but includes the AI Session Assistant and Wiley Practice Planners, which are genuine value adds that competitors do not match at that price point.

One critical pricing consideration: the Therapy Pay payment processing requirement. All practices must use Therapy Pay (Stripe) for client payment collection through the platform. Standard Stripe transaction fees apply. Practices cannot bring their own merchant account or use a preferred payment processor, which removes pricing flexibility on transaction fees.

For a broader comparison of EHR pricing models across the industry, see our EHR cost guide.

Who Should Use TheraNest

Despite the post-acquisition concerns, TheraNest remains a functionally capable platform for specific use cases. It is best suited for:

• Solo therapists and small group practices seeking an affordable entry point. At $29/therapist/month for the Essentials tier, TheraNest offers a low-cost path to digital practice management. Practices that need scheduling, basic documentation, and a client portal -- and do not need insurance billing -- get good value at this tier.
• Practices that value the AI Session Assistant and Wiley Practice Planners. The Premier plan's combination of AI-powered documentation and Wiley's treatment plan library is a genuinely compelling package for therapists who want to minimize documentation time while maintaining clinical rigor. If these two features are high on your priority list, TheraNest is worth evaluating.
• Prescribing clinicians in small practices. Psychiatric prescribers and nurse practitioners who need e-prescribing with EPCS in an affordable therapy-focused platform have fewer options than you might expect. TheraNest, Valant, and a handful of others fill this niche.
• Existing TheraNest users who are satisfied with the current product. If you are already on TheraNest and the post-acquisition changes have not disrupted your workflow, there is no urgent reason to migrate. The core product still works. The question is whether the trajectory gives you confidence for the next 3-5 years.
• Outpatient mental health and counseling practices. The platform's documentation templates, scheduling, and billing workflows are optimized for the outpatient therapy use case -- individual sessions, group sessions, couples therapy, and standard insurance billing.

Who Should NOT Use TheraNest

TheraNest is not the right fit for every organization. Specifically, look elsewhere if you are:

• Practices highly sensitive to vendor stability and support quality. If responsive customer support and vendor stability are your top priorities, the post-acquisition track record should give you pause. TherapyNotes (privately held, strong support reputation) and SimplePractice are safer bets on the support dimension.
• SUD treatment centers, residential programs, or complex behavioral health organizations. TheraNest lacks ASAM-aligned documentation, census/bed management, eMAR, and 42 CFR Part 2 compliance workflows. These organizations need AZZLY Rize, Netsmart, or a similar purpose-built behavioral health platform.
• Large group practices (15+ clinicians) with complex administrative needs. TheraNest's reporting, permissions, and administrative tools were designed for solo and small practices. Large groups will likely outgrow its capabilities and should evaluate Valant or enterprise behavioral health platforms.
• Practices that need full control over payment processing. The mandatory Therapy Pay (Stripe) integration removes the ability to use a preferred merchant account. Practices with negotiated payment processing rates or specific merchant requirements will find this restrictive.
• Therapists who prioritize mobile-first workflows. If you run your practice primarily from your phone, SimplePractice's mobile app is significantly more polished and full-featured than TheraNest's mobile experience.
• Organizations evaluating long-term platform investment. If your selection criteria heavily weight the vendor's product development trajectory and long-term roadmap -- as opposed to current-state features -- the PE ownership pattern warrants caution. Evaluate TheraNest based on what it does today, not what it promises for tomorrow.

Implementation

TheraNest is a cloud-based platform with no on-premise infrastructure requirements. Implementation for a solo practice is straightforward -- most therapists can be operational within a few days. Group practice implementations take longer due to multi-provider configuration, billing setup, and staff training, but typically complete within 2-4 weeks.

• Account setup and configuration. Practice profile, provider credentials, scheduling parameters, and billing information are configured through a guided setup process. The platform provides onboarding resources and documentation for self-guided setup.
• Custom forms and templates. Practices that need custom intake forms, assessments, or documentation templates can build them using the dynamic forms builder. Plan for dedicated time to design and test forms before go-live -- this is where most of the configuration work happens.
• Insurance and billing setup. Practices that will file insurance claims need to set up payer connections, verify clearinghouse enrollment, and configure billing defaults. This process can take 1-2 weeks depending on payer responsiveness.
• Data migration. TheraNest provides data import capabilities for migrating client records from a previous system. The ease of migration depends heavily on the format of your existing data. Practices migrating from another cloud EHR should export data in standard formats (CSV, CCD) and plan for some manual reconciliation.
• Training. The learning curve is moderate for clinicians familiar with practice management software. The AI Session Assistant, custom forms builder, and billing module each require dedicated training time. Ensora provides help documentation and support resources, though the quality of onboarding support has been a point of concern in post-acquisition user reports.

One implementation consideration specific to TheraNest: the Therapy Pay payment processing setup. All practices must configure Therapy Pay (Stripe) for client payment collection. Budget time for merchant account verification and testing before relying on it for live payment collection.

For a comprehensive overview of what to expect during any EHR implementation, see our EHR implementation checklist.

Frequently Asked Questions

Verdict

TheraNest presents a genuinely conflicted evaluation picture. On one hand, the product foundation is solid. The core practice management workflow -- scheduling, documentation, billing, telehealth, e-prescribing, client portal -- is competitive with the therapy EHR market leaders. The AI Session Assistant and Wiley Practice Planners on the Premier plan represent real value that competitors do not fully match at a comparable price point. The $29/therapist/month entry price undercuts most alternatives. On features and price, TheraNest earns its place in the conversation.

On the other hand, the KKR acquisition has introduced the kind of operational changes that should make any prospective buyer do careful diligence. Forced payment processor migration, declining support quality, a confusing rebrand, pricing model changes that increase costs for some users, and engineering resources diverted from product improvement to platform consolidation -- these are not speculative concerns. They are documented patterns reported by existing users. The product still works. The question is whether the ownership structure gives you confidence that it will continue to improve and be well-supported over your 3-5 year planning horizon.

For therapists and practices evaluating TheraNest today, the practical advice is this: evaluate the current product on its merits, use the free trial to test the specific workflows you depend on, verify that billing and payment collection work reliably for your payer mix, and go in with clear eyes about the ownership dynamics. If you need the AI Session Assistant and Wiley Practice Planners, the Premier plan offers a combination that no single competitor fully replicates. If support quality and vendor stability are more important to you than those specific features, TherapyNotes and SimplePractice are lower-risk choices.

Evaluating multiple options? See our behavioral health EHR comparison for a side-by-side look at the leading platforms, or read our EHR selection guide for a structured evaluation framework.