Provider Demographics
NPI:1326795279
Name:LYLES, LAMARCUS
Entity type:Individual
Prefix:
First Name:LAMARCUS
Middle Name:
Last Name:LYLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 CREEKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-5048
Mailing Address - Country:US
Mailing Address - Phone:601-398-6614
Mailing Address - Fax:
Practice Address - Street 1:135 BOUNDS ST STE 108C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4121
Practice Address - Country:US
Practice Address - Phone:601-207-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional