Provider Demographics
NPI:1306263777
Name:BENHAM, MICHELLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BENHAM
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 YGNACIO VALLEY RD
Mailing Address - Street 2:100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3878
Mailing Address - Country:US
Mailing Address - Phone:925-482-3330
Mailing Address - Fax:
Practice Address - Street 1:877 YGNACIO VALLEY RD
Practice Address - Street 2:100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3878
Practice Address - Country:US
Practice Address - Phone:925-482-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst