<Unavail>

LBN: Buck Jack, Llc Dba The Shandy Clinic
<Unavail> is an health care organization with primary practice located at 1325 S Prairie Ave , Pueblo CO 81005-2326. The organization recently has 6 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Behavior Technician, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Speech, Language and Hearing Service Providers / Speech-Language Pathologist. Behavioral Health & Social Service Providers / Behavioral Analyst is the primary health care specialty. Buck Jack, Llc Dba The Shandy Clinic can be contacted via phone (719) 597-0822, or through Denn, Tanner via phone (719) 428-1840.

Contact Information

Primary practice address
1325 S Prairie Ave Pueblo CO 81005-2326
Phone: (719) 597-0822
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Denn, Tanner
Phone: (719) 428-1840

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X

Profile Details

NPI number 1891443370
LBN Legal business name Buck Jack, Llc Dba The Shandy Clinic
DBA Doing business as <Unavail>
Authorized official Denn, Tanner
Entity Organization
Organization subpart 1 No
Enumeration date Mar 14th, 2022
Last updated Feb 28th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891443370 NPPES
Colorado MEDICAID 9000203726

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