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General NPI Number Information
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NPI Number | 1215075866
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Entity Type | Individual
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Provider Name | MELORA JEAN JACOBER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/20/2014
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Provider Practice Location Address
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Address Line | 4500 WILLIAMS DR STE 212-182
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City | GEORGETOWN
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State | TX
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Zip | 78633-1332
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Country | US
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Telephone | 808-938-5205
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Fax | 512-681-7576
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Provider Business Mailing Address
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Address Line | 4500 WILLIAMS DR STE 212-182
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City | GEORGETOWN
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State | TX
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Zip | 78633-1332
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Country | US
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Telephone | 808-938-5205
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Fax | 512-681-7576
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-624
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36495
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23120
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License Number State | CA
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