MEDICARE: SHELBIE MARIE BENKER BCBA, LBA

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	1-24-71480	TX

General Provider Information

NPI Number	:	1093295495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBIE MARIE BENKER BCBA, LBA

Provider Business Mailing Address
First Line	:	10122 WINDING TRAIL RD
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-4059
Country	:	US
Telephone Number	:	562-446-3807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 WINSTED DR APT 5321
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-6188
Country	:	US
Telephone Number	:	562-446-3807
Fax Number	:

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	12/05/2024

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