Healthcare Provider Details

I. General information

NPI: 1306623483
Provider Name (Legal Business Name): BENJAMIN NOEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 01/13/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

IV. Provider business mailing address

1721 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

V. Phone/Fax

Practice location:
  • Phone: 505-318-0251
  • Fax:
Mailing address:
  • Phone: 505-318-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0855
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: