Individual
SHANELLE AMBER BENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW / PSR INSTRUCTOR
Contact information
Practice address
1040 SAKELARES BLVD, GRANTS, NM 87020-3819
(505) 287-2273
(505) 287-2403
Mailing address
1040 SAKELARES BLVD, GRANTS, NM 87020-3819
(505) 287-2273
(505) 287-2403
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
NM
Other
Enumeration date
07/11/2022
Last updated
07/20/2022
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