MEDICARE: ISSUE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1457127862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISSUE INC.

Provider Business Mailing Address
First Line	:	841 SAYRE LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-6206
Country	:	US
Telephone Number	:	310-990-4908
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 SAYRE LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-6206
Country	:	US
Telephone Number	:	310-990-4908
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAN-WILLEM DIKKERS
Credential	:	LMFT #139619
Telephone Number	:	310-990-4908

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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Directions to “ISSUE INC. ” Practice Location

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