Provider Demographics
NPI:1639415524
Name:CLARK, ROBERT DAMIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAMIAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SUSANA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8736
Mailing Address - Country:US
Mailing Address - Phone:443-722-6819
Mailing Address - Fax:
Practice Address - Street 1:3800 S W S YOUNG DR STE 407
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3311
Practice Address - Country:US
Practice Address - Phone:254-252-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist