Melora Jean Jacober, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

36495 Issued in TX

Practice address

4500 Williams Dr
Ste 212-182
Georgetown, TX 78633-1332

Phone

(808) 938-5205

Fax

(512) 681-7576

NPI assigned

Feb 2, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2021 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419033600000",
    "number": "1215075866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 WILLIAMS DR",
            "address_2": "STE 212-182",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331332",
            "telephone_number": "808-938-5205",
            "fax_number": "512-681-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 WILLIAMS DR",
            "address_2": "STE 212-182",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331332",
            "telephone_number": "808-938-5205",
            "fax_number": "512-681-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBER",
        "first_name": "MELORA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2014-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY-624",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "36495",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "23120",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Jabalie
• Jack Jones Hearing Center Inc
• Nancy C Jackson, RN, FNP-C
• Shai Keyajah Jackson
• Shanna Marie Jackson, DC
• Jacqueline Kozak
• Samantha Jai Jaekel, M.S., CF-SLP
• Christopher Earl Jaisingh, FNP-C
• James B Thompson MD PA
• Jan Douglass

• Clinical Psychologist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.