Active NPI
Kimberly Lyles, MSW
- Case Manager/Care Coordinator
- McComb, MS
National Provider Identifier
1801316294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1701 White St
McComb, MS 39648 - Phone
- (601) 249-4214
- Fax
- (601) 249-4234
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | |||
| Social Worker | 104100000X | 13504 | LA | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1701 White St
McComb, MS 39648
Mailing address
1701 White St
PO Box 768
McComb, MS 39648
Phone (601) 249-4214
Other practice location 1
11847 Bricksome Ave Ste D
Baton Rouge, LA 70816-2328
Phone (601) 597-7291
Other practice location 2
12090 S Harrells Ferry Rd Ste L
Baton Rouge, LA 70816
Phone (601) 597-7291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 640897031 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13504 | LA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Striving 4 Excellence Behavioral Healthcare, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Baton Rouge, LA
- NPI 1790273654
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674172800000",
"number": "1801316294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 WHITE ST",
"address_2": "PO BOX 768",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-249-4214",
"fax_number": "601-249-4234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 WHITE ST",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-249-4214",
"fax_number": "601-249-4234"
}
],
"practiceLocations": [
{
"address_1": "11847 Bricksome Ave Ste D",
"address_purpose": "LOCATION",
"city": "Baton Rouge",
"state": "LA",
"postal_code": "708162328",
"country_code": "US",
"telephone_number": "601-597-7291",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12090 S Harrells Ferry Rd Ste L",
"address_purpose": "LOCATION",
"city": "Baton Rouge",
"state": "LA",
"postal_code": "70816",
"country_code": "US",
"telephone_number": "601-597-7291",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LYLES",
"first_name": "KIMBERLY",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-27",
"last_updated": "2023-01-20",
"certification_date": "2023-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "LA",
"license": "13504",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "640897031",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.