MEDICARE: BEHAVIOR LEARNING AND DEVELOPMENT GROUP, LLC

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

General Provider Information

NPI Number	:	1558225896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR LEARNING AND DEVELOPMENT GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246-0279
Country	:	US
Telephone Number	:	209-268-0868
Fax Number	:	209-254-7900

Provider Business Practice Location Address
First Line	:	1906 VISTA DEL LAGO DR STE I
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9700
Country	:	US
Telephone Number	:	209-268-0868
Fax Number	:	209-254-7900

Authorized Official
Title or Position	:	CO-OWNER
Name	:	THERESA MARIE BENAVIDEZ
Credential	:	BCBA
Telephone Number	:	915-249-0365

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	02/11/2026

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