Provider Demographics
NPI:1659682383
Name:BARRY JAY, PH.D., P.L.L.C.
Entity Type:Organization
Organization Name:BARRY JAY, PH.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-626-8889
Mailing Address - Street 1:6022 W MAPLE RD
Mailing Address - Street 2:STE 414
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4408
Mailing Address - Country:US
Mailing Address - Phone:248-626-8889
Mailing Address - Fax:248-366-1126
Practice Address - Street 1:6022 W MAPLE RD
Practice Address - Street 2:STE 414
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4408
Practice Address - Country:US
Practice Address - Phone:248-626-8889
Practice Address - Fax:248-366-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002993251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health