Provider Demographics
NPI:1467517029
Name:SOLOMON, JAY RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:RICHARD
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 SAN FELIPE ST
Mailing Address - Street 2:SUITE 248
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:713-710-7715
Mailing Address - Fax:713-974-3081
Practice Address - Street 1:7887 SAN FELIPE
Practice Address - Street 2:SUITE 248
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063
Practice Address - Country:US
Practice Address - Phone:713-710-7715
Practice Address - Fax:713-974-3081
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00D08RMedicare ID - Type Unspecified