Embedding counselors in various campus locations has been one strategy to address the student mental health crisis. The aim of this study was to evaluate challenges to implementing the primary care behavioral health (PCBH) model, in which behavioral health counselors (BHCs) are embedded within the college health center, and to explore characteristics associated with differing levels of PCBH fidelity. Seventy-one BHCs working in college health centers completed the online fidelity survey. Most respondent scores denoted moderate or strong fidelity to the PCBH model. Psychologists showed better adherence to autonomous clinical aspects of PCBH while social workers/counselors showed better adherence to collaborative aspects of PCBH. Overall findings suggest fidelity to PCBH by BHCs in college health is driven by independent clinical activity more than interdisciplinary collaboration. Strategies for developing and evaluating a PCBH program that complements the specialty mental health services offered through counseling centers are discussed.