Provider Demographics
NPI:1205727740
Name:KOETTEL, DESIREE KARA (LAC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:KARA
Last Name:KOETTEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-9235
Mailing Address - Country:US
Mailing Address - Phone:501-941-8824
Mailing Address - Fax:
Practice Address - Street 1:802 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2548
Practice Address - Country:US
Practice Address - Phone:501-232-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2507013101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor