Healthcare Provider Details

I. General information

NPI: 1629760327
Provider Name (Legal Business Name): VERDANT COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 500
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

2210 COLDSTREAM AVE NE
CEDAR RAPIDS IA
52402-3719
US

V. Phone/Fax

Practice location:
  • Phone: 319-200-5670
  • Fax:
Mailing address:
  • Phone: 319-573-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TINA ISSA
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: LMHC
Phone: 319-200-5670