Jaclyn Grad, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

001304 Issued in IA

Practice address

3851 Roger Brooke Dr
McHeqd
Fort Sam Houston, TX 78234-4501

Phone

(210) 916-2460

NPI assigned

Sep 12, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Peters Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Octave Behavioral Health PC

  • Psychologist
  • San Francisco, CA
  • NPI 1184199549
  NPD (past)

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1972885440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280148",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322280148",
            "telephone_number": "904-270-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "address_2": "MCHEQD",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344501",
            "telephone_number": "210-916-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAD",
        "first_name": "JACLYN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-12",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "001304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "PETERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan Meister Gorog Jr., DO
• Montez Gorrell-Goode, FNP
• Jessica Lynn Gottula, MD
• Courtney Marie Gourley, PA-C
• Larry Lee Grabhorn, M.D.
• Donna Graf, LCSW
• Adrian Grant, MD
• Kurt William Grathwohl, M.D.
• Kenneth Jerome Graves, PH.D.
• Lawrence Charles Gray II, MD

• Psychologist in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; 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.