| Buck Jack Llc | |
|
901 N Santa Fe Ave Fountain CO 80817-1738 | |
| (719) 822-0550 | |
| (719) 599-4606 |
| Full Name | Buck Jack Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 901 N Santa Fe Ave, Fountain, 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 901 N Santa Fe Ave Fountain CO 80817-1738 Ph: (719) 822-0550 |
| NPI Number | 1558972596 |
|---|---|
| Provider Enumeration Date | 08/13/2020 |
| Last Update Date | 08/13/2020 |
| Certification Date | 08/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558972596 | NPI | - | NPPES |
| 9000181601 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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