Provider Demographics
NPI:1952709875
Name:JACOBY, VANESSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR # 7792
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:254-449-3298
Mailing Address - Fax:
Practice Address - Street 1:3567 62ND & SANTA FE
Practice Address - Street 2:
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76554-5005
Practice Address - Country:US
Practice Address - Phone:254-288-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical