Healthcare Provider Details

I. General information

NPI: 1932038338
Provider Name (Legal Business Name): JACOB RAYIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20965 POTOMAC ST
SOUTHFIELD MI
48076-2385
US

IV. Provider business mailing address

20965 POTOMAC ST
SOUTHFIELD MI
48076-2385
US

V. Phone/Fax

Practice location:
  • Phone: 248-648-1296
  • Fax:
Mailing address:
  • Phone: 248-648-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB JOSEPH RAYIS
Title or Position: OWNER
Credential: LMSW
Phone: 248-648-1296