Individual provider Active NPI

Tina Elizabeth Issa, LMHC

  • Mental Health Counselor
  • Cedar Rapids, IA
National Provider Identifier
1750536256
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
001103 Issued in IA
Practice address
3900 Fountains Blvd NE Ste 203
Cedar Rapids, IA 52411-6610
Phone
(319) 356-6352
Fax
(319) 358-2367
NPI assigned
Nov 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 001103 IA Primary

Addresses

Primary practice location

3900 Fountains Blvd NE Ste 203
Cedar Rapids, IA 52411-6610

Mailing address

1290 Jordan St
North Liberty, IA 52317-8020
Phone (319) 356-6352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
001103IAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Verdant Counseling, Inc Mental Health Current Accepting new patients
Psychiatric Associates of Iowa, PC CurrentSince Feb 6, 2022 Accepting new patients
Psychiatric Associates of Iowa, PC CurrentSince Feb 6, 2022 Accepting new patients

Locations

3900 Fountains Blvd NE
Ste 203
Cedar Rapids, IA 52411
Phone (319) 727-8297

1290 Jordan St
North Liberty, IA 52317
Phone (319) 356-6352

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1750536256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 JORDAN ST",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523178020",
            "telephone_number": "319-356-6352",
            "fax_number": "319-358-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FOUNTAINS BLVD NE STE 203",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524116610",
            "telephone_number": "319-356-6352",
            "fax_number": "319-358-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISSA",
        "first_name": "TINA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-25",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.