Provider Demographics
NPI:1417314725
Name:JYLES, EUNA (MHP, MHT, & BHT)
Entity Type:Individual
Prefix:
First Name:EUNA
Middle Name:
Last Name:JYLES
Suffix:
Gender:F
Credentials:MHP, MHT, & BHT
Other - Prefix:
Other - First Name:EUNA
Other - Middle Name:RENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 LEONARD RD LOT F
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-6643
Mailing Address - Country:US
Mailing Address - Phone:601-341-9158
Mailing Address - Fax:
Practice Address - Street 1:860 E RIVER PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202
Practice Address - Country:US
Practice Address - Phone:601-398-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health