| Buck Jack, Llc | |
|
6436 S Us Highway 85-87 Ste U Fountain CO 80817-1007 | |
| (719) 597-0822 | |
| (719) 599-4606 |
| Full Name | Buck Jack, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 6436 S Us Highway 85-87 Ste U, Fountain, Colorado |
| Authorized Official Name and Position | Tanner Hall (INTERNAL OPERATIONS MANAGER) |
| Authorized Official Contact | 7195970822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Buck Jack, Llc 2233 Academy Pl Ste 200 Colorado Springs CO 80909-1666 Ph: (719) 597-0822 | Buck Jack, Llc 6436 S Us Highway 85-87 Ste U Fountain CO 80817-1007 Ph: (719) 597-0822 |
| NPI Number | 1003618729 |
|---|---|
| Provider Enumeration Date | 03/25/2025 |
| Last Update Date | 03/25/2025 |
| Certification Date | 03/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003618729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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