Organization
COUNSELING AND PSYCHOTHERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARY LEONARD CLARK (OWNER)
(817) 782-1006
Entity
Organization
Contact information
Practice address
6461 SOUTHWEST BLVD, BENBROOK, TX 76132-2777
(817) 782-1006
Mailing address
6461 SOUTHWEST BLVD, FORT WORTH, TX 76132
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8755
TX
Other
Enumeration date
01/10/2008
Last updated
01/10/2008
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