Individual
DR. ROGER GALEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
BLANCHFIELD ARMY COMMUNITY HOSPITAL, 650 JOEL DR, FORT CAMPBELL, KY 42223-5349
(270) 956-0129
Mailing address
BLANCHFIELD ARMY COMMUNITY HOSPITAL, 650 JOEL DRIVE, FORT CAMPBELL, KY 42223-5349
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1187
KY
103T00000X
Psychologist
2800
TN
103TP0016X
Prescribing (Medical) Psychologist
Primary
322138
LA
Other
Enumeration date
03/02/2007
Last updated
05/31/2023
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