Individual provider Active NPI

Brooklee Lightsey Tynes, M.A.

  • Psychologist
  • Hattiesburg, MS
National Provider Identifier
1255783056
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
631171 Issued in MS
Practice address
102 Medical Park Ste B
Hattiesburg, MS 39401-9080
Phone
(601) 261-1650
NPI assigned
Jul 6, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X 631171 MS
Psychologist 103T00000X 631171 MS Primary

Addresses

Primary practice location

102 Medical Park Ste B
Hattiesburg, MS 39401-9080

Mailing address

143 Dove Holw
Petal, MS 39465-7800
Phone (601) 543-3008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210524002210 NE Practitioner - Clinical Psychologist 3375942352 Reassigns benefits to 1 organization
I20230816002674 MS Practitioner - Clinical Psychologist 3375942352 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1054NEMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Jul 31, 2023 Accepting new patients
Faith Regional Physician Services, LLC CurrentSince Apr 21, 2021 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jul 31, 2023 Accepting new patients
Faith Regional Physician Services, LLC CurrentSince Apr 21, 2021 Accepting new patients
State of Mississippi - University of Mississippi Medical Center PastSince Aug 13, 2023 Accepting new patients

Locations

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

47452 268 Ave
Ste C
Humphrey, NE 68642
Phone (402) 923-0150

2600 W Norfolk Ave
Ste 200
Norfolk, NE 68701
Phone (402) 844-8194

Interoperability endpoints

  • Direct secure messaging: btynes131554@directpatientrecord.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1255783056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 DOVE HOLW",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394657800",
            "telephone_number": "601-543-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MEDICAL PARK STE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394019080",
            "telephone_number": "601-261-1650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYNES",
        "first_name": "BROOKLEE",
        "middle_name": "LIGHTSEY",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-06",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "631171",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "631171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.