MEDICARE: MRS. THERESA MARIE BENAVIDEZ BCBA, M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-17-25819	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821530551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA MARIE BENAVIDEZ BCBA, M.A.

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0279
Country	:	US
Telephone Number	:	915-249-0365
Fax Number	:

Provider Business Practice Location Address
First Line	:	8298 CAVE CITY RD
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0279
Country	:	US
Telephone Number	:	915-249-0365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	03/11/2026

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