Provider Demographics
NPI:1215075866
Name:JACOBER, MELORA JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELORA
Middle Name:JEAN
Last Name:JACOBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 WILLIAMS DR
Mailing Address - Street 2:STE 212-182
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1332
Mailing Address - Country:US
Mailing Address - Phone:808-938-5205
Mailing Address - Fax:512-681-7576
Practice Address - Street 1:4500 WILLIAMS DR
Practice Address - Street 2:STE 212-182
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1332
Practice Address - Country:US
Practice Address - Phone:808-938-5205
Practice Address - Fax:512-681-7576
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-624103TC0700X
TX36495103TC0700X
CA23120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50869Medicare ID - Type Unspecified