Provider Demographics
NPI:1174213581
Name:SMALL, CHRISTYN MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTYN
Middle Name:MARIE
Last Name:SMALL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 MENAUL BLVD NE STE B460
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2250
Mailing Address - Country:US
Mailing Address - Phone:505-321-8205
Mailing Address - Fax:
Practice Address - Street 1:5800 MENAUL BLVD NE STE B460
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3238
Practice Address - Country:US
Practice Address - Phone:505-974-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional