Healthcare Provider Details

I. General information

NPI: 1508701384
Provider Name (Legal Business Name): JEREMIAH BINEI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 HAZELDINE AVE SE
ALBUQUERQUE NM
87106-4321
US

IV. Provider business mailing address

1415 HAZELDINE AVE SE
ALBUQUERQUE NM
87106-4321
US

V. Phone/Fax

Practice location:
  • Phone: 505-578-2641
  • Fax:
Mailing address:
  • Phone: 505-578-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: