MEDICARE: TCLLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1669084133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCLLLC

Provider Business Mailing Address
First Line	:	3107 W COLORADO AVE # 118
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2040
Country	:	US
Telephone Number	:	720-563-1736
Fax Number	:	855-965-0935

Provider Business Practice Location Address
First Line	:	2822 W CUEHARRAS ST.
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	720-563-1736
Fax Number	:	855-965-0935

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	MR. TAYLOR C LOUCKS
Credential	:	M.S., BCBA
Telephone Number	:	720-563-1736

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	04/23/2024

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Directions to “TCLLLC ” Practice Location

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