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General NPI Number Information
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NPI Number | 1336652460
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Entity Type | Individual
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Provider Name | KARISSA SAMARA TOBEY MA, LCPC
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Gender |
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Dates
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Enumeration Date | 11/11/2017
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Last Update Date | 04/28/2024
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Provider Practice Location Address
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Address Line | 2035 FOXFIELD RD STE 202
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City | SAINT CHARLES
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State | IL
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Zip | 60174-5750
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Country | US
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Telephone | 630-425-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 FOXFIELD RD STE 202
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City | ST CHARLES
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State | IL
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Zip | 60174-5750
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Country | US
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Telephone | 630-425-2025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.013451
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.014784
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License Number State | IL
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