Provider Demographics
NPI:1659492635
Name:DR. CLAIRE JACOBS
Entity type:Organization
Organization Name:DR. CLAIRE JACOBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:OSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-403-2050
Mailing Address - Street 1:14607 SAN PEDRO,
Mailing Address - Street 2:SUITE 295
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4325
Mailing Address - Country:US
Mailing Address - Phone:210-403-2050
Mailing Address - Fax:210-403-9890
Practice Address - Street 1:14607 SAN PEDRO
Practice Address - Street 2:SUITE 295
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4325
Practice Address - Country:US
Practice Address - Phone:210-403-2050
Practice Address - Fax:210-403-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23850103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033967301Medicaid
TX00J12PMedicare ID - Type UnspecifiedMCARE PROV #