Healthcare Provider Details

I. General information

NPI: 1558075168
Provider Name (Legal Business Name): MELISSA LOUISE LYLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BOUNDS ST STE 108C
JACKSON MS
39206-4121
US

IV. Provider business mailing address

135 BOUNDS ST STE 108C
JACKSON MS
39206-4121
US

V. Phone/Fax

Practice location:
  • Phone: 601-207-2226
  • Fax:
Mailing address:
  • Phone: 601-207-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC10350
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: