Provider Demographics
NPI:1750536256
Name:ISSA, TINA ELIZABETH (LMHC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:ELIZABETH
Last Name:ISSA
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 1:1290 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8020
Mailing Address - Country:US
Mailing Address - Phone:319-356-6352
Mailing Address - Fax:319-358-2367
Practice Address - Street 1:3900 FOUNTAINS BLVD NE STE 203
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-6610
Practice Address - Country:US
Practice Address - Phone:319-356-6352
Practice Address - Fax:319-358-2367
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health