Healthcare Provider Details

I. General information

NPI: 1124206271
Provider Name (Legal Business Name): LES A BINNIX PMHNP, LPCMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CARLSBAD CT
LUSBY MD
20657-4822
US

IV. Provider business mailing address

685 CARLSBAD CT
LUSBY MD
20657-4822
US

V. Phone/Fax

Practice location:
  • Phone: 818-438-8548
  • Fax: 410-630-3690
Mailing address:
  • Phone: 818-438-8548
  • Fax: 410-630-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR241003
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPMH1280
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC0000419
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: