Provider Demographics
NPI:1861227415
Name:LYALS, DESTINY S (LMHC)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:S
Last Name:LYALS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4247
Mailing Address - Country:US
Mailing Address - Phone:352-461-6185
Mailing Address - Fax:
Practice Address - Street 1:1131 NW 64TH TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4261
Practice Address - Country:US
Practice Address - Phone:396-906-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health