Local SEO does not apply, and most agencies do not notice
A generalist agency takes a telepsych practice, claims a Google Business Profile at the founder's home address, and starts optimizing for a city. Six months later the practice ranks for one suburb and is invisible in the twelve other states it is licensed in.
The searcher is not looking for a nearby office. They are typing psychiatrist that takes Aetna in Ohio, or online psychiatrist Texas same week, or adhd evaluation online Florida. Those queries carry a state and often a payer, and each one needs a page that answers both.
The correct architecture is a state page per licensed state, condition pages that cross those states, and payer pages where you are in network. That is thirty to eighty real pages for a mid-sized practice, and most of them have to be written by someone who knows psychiatry, not spun from a template.