Healthcare Provider Details

I. General information

NPI: 1609792688
Provider Name (Legal Business Name): JAY R. BARROW DTLLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 PAULINE BLVD STE 21C
ANN ARBOR MI
48103-5021
US

IV. Provider business mailing address

3044 W JOY RD
ANN ARBOR MI
48105-9612
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-7739
  • Fax:
Mailing address:
  • Phone: 865-309-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352001165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: