Provider Demographics
NPI:1336652460
Name:TOBEY, KARISSA SAMARA (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:SAMARA
Last Name:TOBEY
Suffix:
Gender:X
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E ROOSEVELT RD STE 8
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2035 FOXFIELD RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5750
Practice Address - Country:US
Practice Address - Phone:630-425-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013451101YP2500X
IL180.014784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional