Individual
KIMBERLY LYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648
(601) 249-4214
(601) 249-4234
Mailing address
1701 WHITE ST, PO BOX 768, MCCOMB, MS 39648
(601) 249-4214
(601) 249-4234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
13504
LA
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
640897031
—
LA
Enumeration date
06/27/2017
Last updated
01/20/2023
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