Individual
DESTINEE G TYRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-1298
Mailing address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-1298
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A2602002
AR
106S00000X
Behavior Technician
Primary
RBT-22-225099
AR
Other
Enumeration date
07/29/2022
Last updated
02/20/2026
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