Healthcare Provider Details

I. General information

NPI: 1528878527
Provider Name (Legal Business Name): CHAYA CITRIN MC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 N HIGHWAY 14 STE B9
CEDAR CREST NM
87008-9538
US

IV. Provider business mailing address

1212 CALLE DEL SOL NE
ALBUQUERQUE NM
87106-1911
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-7771
  • Fax:
Mailing address:
  • Phone: 575-517-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0416
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: