| Buck Jack Llc | |
|
17230 Jackson Creek Pkwy Ste 220 Monument CO 80132-7304 | |
| (719) 488-3348 | |
| (719) 599-4606 |
| Full Name | Buck Jack Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 17230 Jackson Creek Pkwy Ste 220, Monument, Colorado |
| Authorized Official Name and Position | William Colt (PRESIDENT) |
| Authorized Official Contact | 7134106889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Buck Jack Llc 685 Citadel Dr E Ste 580 Colorado Springs CO 80909-5381 Ph: (713) 410-6889 | Buck Jack Llc 17230 Jackson Creek Pkwy Ste 220 Monument CO 80132-7304 Ph: (719) 488-3348 |
| NPI Number | 1407467707 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407467707 | NPI | - | NPPES |
| 9000181601 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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