Individual provider · Type 1 NPI

Destinee G. Tyra, LAC

Mental Health Counselor · Russellville, AR

NPI number 1457087553 Active

Practice location

110 Skyline Dr
Russellville, AR 72801-3362

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XA2602002 (AR)

Mental Health Counselor: Definition to come...

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About NPI 1457087553

Destinee G. Tyra, LAC's National Provider Identifier is 1457087553, issued on Jul 29, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Russellville, AR. The record was last updated on Feb 20, 2026.