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General NPI Number Information
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NPI Number | 1952252231
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Entity Type | Organization
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Legal Business Name | BUCK JACK UTAH, LLC
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 2005 E 2700 S STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-1766
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Country | US
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Telephone | 719-597-0822
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Fax | 719-599-4606
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Provider Business Mailing Address
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Address Line | 2233 ACADEMY PL STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1666
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Country | US
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Telephone | 719-597-0822
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Fax | 719-599-4606
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Authorized Official
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Title or Position | INTERNAL OPERATIONS MANAGER
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Name | TANNER HALL
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Credential |
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Telephone | 719-597-0822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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