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
6190 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 247-1511
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
08/06/2020
Last updated
08/16/2020
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