Provider Demographics
NPI:1649356395
Name:KELLEY, JAY DANIEL (LPC LCDC)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:DANIEL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 EASTON COMMONS
Mailing Address - Street 2:#1404
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:281-587-5333
Mailing Address - Fax:
Practice Address - Street 1:11600 JONES RD
Practice Address - Street 2:#108 10
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-587-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219101YA0400X
TX10634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)