Samantha Jacobson, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

005707 Issued in AZ

Practice address

8652 E Eastridge Rd Ste 201
Prescott Valley, AZ 86314-9464

Phone

(928) 830-2410

NPI assigned

Apr 8, 2026

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• One Psychological Services

  • Psychologist
  • Prescott Valley, AZ
  • NPI 1790603470
  NPD (past)

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

{
    "created_epoch": "1775606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1912849860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3256 W HUNTINGTON DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850414339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8652 E EASTRIDGE RD STE 201",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863149464",
            "telephone_number": "928-830-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "SAMANTHA",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-08",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "AZ",
            "license": "005707",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "005507",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "005707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrative Pain Centres of Prescott
• Integrative Pain Centres of Prescott
• Internal Medicine Specialists of Prescott Valley Arizona,PC
• Krista Iverson, RN
• Lauraine M Jackson, FNP-BC
• Kavita Devi Jaikaran, DNP
• Karen M Jamison, NP
• Adrian Jantzi
• Kaylynn Nicole Janulewicz, LMT
• David Jenson, DNP, PMHNP, FNP

• Clinical Neuropsychologist in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Clinical Neuropsychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.