| Buck Jack, Llc | |
|
17230 Jackson Creek Pkwy Ste 220 Monument CO 80132-7304 | |
| (719) 597-0822 | |
| (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 | Tanner Hall (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7195970822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Buck Jack, Llc 2233 Academy Pl Ste 200 Colorado Springs CO 80909-1666 Ph: (719) 597-0822 | Buck Jack, Llc 17230 Jackson Creek Pkwy Ste 220 Monument CO 80132-7304 Ph: (719) 597-0822 |
| NPI Number | 1154139350 |
|---|---|
| Provider Enumeration Date | 12/20/2024 |
| Last Update Date | 12/20/2024 |
| Certification Date | 12/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154139350 | NPI | - | NPPES |
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Buck Jack Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 17230 Jackson Creek Pkwy Ste 220, Monument, CO 80132 Phone: 719-597-0822 Fax: 719-599-4606 |