Provider Demographics
NPI:1972753564
Name:KINNEY, LISA LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 6 WEST
Mailing Address - Street 2:VA HOSPITAL
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2208
Mailing Address - Country:US
Mailing Address - Phone:563-599-9982
Mailing Address - Fax:
Practice Address - Street 1:2979 VICTORIA STREET
Practice Address - Street 2:QUAD CITIESVA OUTPATIENT CLINIC
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-599-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003182101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)