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DESTINEE G TYRA LAC
NPI 1457087553
Counselor - Mental Health in Russellville, AR

Active since July 29, 2022
110 SKYLINE DR, RUSSELLVILLE, AR 72801(479) 968-1298 Get Directions Write a Review

NPPES record last updated: February 20, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 19, 2022, Jul 29, 2022 (2 updates tracked since 2022).

About Destinee G Tyra Lac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DESTINEE G TYRA LAC (NPI 1457087553) is an individual mental health provider in Russellville, Arkansas, licensed in Arkansas (A2602002) and active in the NPI registry since July 2022.

NPPES Registry Identity

NPI1457087553
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameDESTINEE G TYRACredential: LAC
Location Address110 SKYLINE DRRussellville, AR 72801-3362
Mailing Address110 Skyline DrRussellville, AR 72801-3362 · (479) 968-1298
Phone(479) 968-1298
Sole ProprietorNo
Enumeration DateJuly 29, 2022
Last NPPES UpdateFebruary 20, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 20, 2026
✔ NPI 1457087553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in AR · A2602002
110 SKYLINE DR, Russellville, AR 72801
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Other Names 1

Former Name (1)Destinee Penzo

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEGAN ROSHAWN FORD
Counselor (Mental Health)
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 967-5570
CHARLES ARMSTRONG
Case Manager/Care Coordinator
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 968-1298
LINDSEY HOWARD
Case Manager/Care Coordinator
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 968-1298
KARLESHA LIVINGSTON
Social Worker (School)
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 968-1298
MEGAN MOORE
Case Manager/Care Coordinator
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 968-1298
BRITTANY THACKER LPN
Licensed Practical Nurse
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 967-5570
SARAH KATE HENDERSON
Case Manager/Care Coordinator
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 968-1298
ERIN WILLCUTT M.A. LAC
Counselor (Mental Health)
110 SKYLINE DR
RUSSELLVILLE, AR 72801
Pope County (479) 967-5570

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Destinee Tyra's NPI number?

The NPI number for Destinee Tyra is 1457087553. It was assigned to this individual provider in the NPPES registry on July 29, 2022. The provider is also known as Destinee Penzo.

Where is Destinee Tyra located?

Destinee Tyra practices at 110 Skyline Dr, Russellville, AR 72801. The listed phone number is (479) 968-1298.

What is Destinee Tyra's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Destinee Tyra was last updated on February 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.