Healthcare Provider Details

I. General information

NPI: 1790614824
Provider Name (Legal Business Name): TAMAR JONES LUCAS, PMHNP- BC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MUELLER BRASS RD STE A
FULTON MS
38843-8430
US

IV. Provider business mailing address

201 MUELLER BRASS RD STE A
FULTON MS
38843-8430
US

V. Phone/Fax

Practice location:
  • Phone: 662-409-2094
  • Fax: 949-864-1359
Mailing address:
  • Phone: 662-409-2094
  • Fax: 949-864-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMAR JONES LUCAS
Title or Position: OWNER
Credential: ED.D, MSN, PMHNP-BC
Phone: 662-409-2094