BUCK JACK LLC
NPI 1407467707
Behavior Analyst in Monument, CO

Q: What is Buck Jack LLC's NPI number?

The NPI number for Buck Jack LLC is 1407467707. It was assigned to this organization in the NPPES registry on August 11, 2020. The provider is doing business as The Shandy Clinic.

Q: What is Buck Jack LLC's specialty?

The primary specialty registered for this NPI is Behavior Analyst with taxonomy code 103K00000X.

Q: When was this NPI record last updated?

The NPPES record for Buck Jack LLC was last updated on August 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 11, 2020

17230 JACKSON CREEK PKWY STE 220, MONUMENT, CO 80132(719) 488-3348(719) 599-4606 Get Directions Write a Review

NPPES record last updated: August 11, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Buck Jack Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BUCK JACK LLC (NPI 1407467707), doing business as The Shandy Clinic, is a healthcare organization registered as a behavior analyst in Monument, Colorado and active in the NPI registry since August 2020. The organization lists William Colt, President, as its authorized official.

NPPES Registry Identity

NPI1407467707

Entity TypeOrganization

Primary Taxonomy103K00000X

Legal Business NameBUCK JACK LLC

Location Address17230 JACKSON CREEK PKWY STE 220Monument, CO 80132-7304

Mailing Address685 Citadel Dr E Ste 580Colorado Springs, CO 80909-5381 · (713) 410-6889

Phone(719) 488-3348

Fax(719) 599-4606

Organization SubpartNo

Authorized OfficialWilliam ColtPresident · (713) 410-6889

Enumeration DateAugust 11, 2020

NPPES CertifiedAugust 11, 2020

✔ NPI 1407467707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyBehavior AnalystBehavioral Health & Social Service Providers

Taxonomy Code103K00000X

Definition

A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.

17230 JACKSON CREEK PKWY STE 220, Monument, CO 80132

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Other Names 1

Doing Business AsThe Shandy Clinic

Other Identifiers 1

Medicaid9000181601CO

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUSAN MARIE MCDONALD

Behavior Technician