Provider Demographics
NPI:1093295495
Name:BENKER, SHELBIE MARIE
Entity Type:Individual
Prefix:
First Name:SHELBIE
Middle Name:MARIE
Last Name:BENKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10122 WINDING TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4059
Mailing Address - Country:US
Mailing Address - Phone:562-446-3807
Mailing Address - Fax:
Practice Address - Street 1:10122 WINDING TRAIL RD
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4059
Practice Address - Country:US
Practice Address - Phone:562-446-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-51970106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician