Provider Demographics
NPI:1205856101
Name:PSYCHOTHERAPY & ORGANIZATIONAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY & ORGANIZATIONAL DEVELOPMENT LLC
Other - Org Name:CARLTON F 'PERK' CLARK, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-519-8475
Mailing Address - Street 1:350 S WILLIAMS BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7416
Mailing Address - Country:US
Mailing Address - Phone:520-519-8475
Mailing Address - Fax:520-519-8476
Practice Address - Street 1:350 S WILLIAMS BLVD
Practice Address - Street 2:STE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7416
Practice Address - Country:US
Practice Address - Phone:520-519-8475
Practice Address - Fax:520-519-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty