Organization
BUCK JACK LLC
Active
Other names
The Shandy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM COLT (PRESIDENT)
(713) 410-6889
Entity
Organization
Contact information
Practice address
3131 S VAUGHN WAY STE 110, AURORA, CO 80014-3501
(303) 755-5534
(303) 357-6146
Mailing address
685 CITADEL DR E STE 580, COLORADO SPRINGS, CO 80909-5381
(713) 725-9181
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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