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General NPI Number Information
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NPI Number | 1912849860
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Entity Type | Individual
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Provider Name | SAMANTHA JACOBSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 8652 E EASTRIDGE RD STE 201
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-9464
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Country | US
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Telephone | 928-830-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 3256 W HUNTINGTON DR
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City | PHOENIX
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State | AZ
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Zip | 85041-4339
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Country | US
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Telephone |
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 005707
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License Number State | AZ
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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 | 005507
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 005707
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License Number State | AZ
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