Organization
BUCK JACK LLC
Active
Other names
The Shandy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM COLT (PRESIDENT)
(713) 410-6889
Entity
Organization
Contact information
Practice address
17230 JACKSON CREEK PKWY STE 220, MONUMENT, CO 80132-7304
(719) 488-3348
(719) 599-4606
Mailing address
685 CITADEL DR E STE 580, COLORADO SPRINGS, CO 80909-5381
(713) 410-6889
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000181601
—
CO
Enumeration date
08/11/2020
Last updated
08/11/2020
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