Provider Demographics
NPI:1225684830
Name:CITRIN, LAURA B (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:CITRIN
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GOVERNOR STEVENS AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3455
Mailing Address - Country:US
Mailing Address - Phone:360-890-5633
Mailing Address - Fax:
Practice Address - Street 1:1001 COOPER POINT RD SW
Practice Address - Street 2:STE 140-740
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9850
Practice Address - Country:US
Practice Address - Phone:360-890-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61235227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty