Buck Jack LLC
Organization Active NPI Behavior Analyst · Monument, CO
NPI 1407467707 · NPPES record last updated Aug 11, 2020
Key facts
- NPI
- 1407467707
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Behavior Analyst 103K00000X
- Legal business name
- BUCK JACK LLC
- Practice address
- 17230 Jackson Creek Pkwy Ste 220
Monument, CO 80132-7304 - Phone
- (719) 488-3348
- Fax
- (719) 599-4606
- NPI assigned
- Aug 11, 2020
- Organization subpart
- No
Authorized official
- Name
- William Colt
- Title
- President
- Phone
- (713) 410-6889
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Buck Jack LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst |
103K00000X | Yes |
Addresses
Primary practice location
17230 Jackson Creek Pkwy Ste 220
Monument, CO 80132-7304
Mailing address
685 Citadel Dr E Ste 580
Colorado Springs, CO 80909-5381
Phone (713) 410-6889
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000181601 | Medicaid | CO |
Other names
- The Shandy Clinic
Other providers in Monument, CO
- Alexandra Marie Brown
- Marian Ama Brusco
- Alicia Bryant
- BSLC Monument, LLC
- Buck Jack LLC
- Buck Jack LLC
- Buck Jack, LLC
- Buck Jack, LLC
- Amy Burgess
- Arlie Eugene Burnham Jr.
All providers in Monument, CO · Behavior Analyst in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.