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General NPI Number Information
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NPI Number | 1639415524
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Entity Type | Individual
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Provider Name | ROBERT DAMIAN CLARK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 3800 S W S YOUNG DR STE 407
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City | KILLEEN
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State | TX
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Zip | 76542-3311
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Country | US
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Telephone | 254-252-3748
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Fax |
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Provider Business Mailing Address
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Address Line | 207 SUSANA DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-8736
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Country | US
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Telephone | 443-722-6819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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