Individual provider Active NPI

Maria Camila Tobon

  • Mental Health Counselor
  • Waukegan, IL
National Provider Identifier
1720774359
Registry record updated Sep 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
415 Washington St Ste 200
Waukegan, IL 60085-5564
Phone
(224) 392-1245
NPI assigned
Apr 17, 2023
Last updated
Sep 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

415 Washington St Ste 200
Waukegan, IL 60085-5564

Mailing address

415 Washington St Ste 200
Waukegan, IL 60085-5564
Phone (224) 255-6050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251015004979 IL Practitioner - Mental Health Counselor 7618464306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

111 N Orange Ave
Suite 800
Orlando, FL 32801-2381

3310 Old Mill Rd
Northbrook, IL 60062-6324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Josselyn Center NFP Current Accepting new patients
The Josselyn Center CurrentSince Sep 12, 2025 Accepting new patients
The Josselyn Center NFP CurrentSince Jul 21, 2024 Accepting new patients
The Josselyn Center NFP CurrentSince Sep 12, 2025 Accepting new patients

Locations

1135 Skokie Blvd
Northbrook, IL 60062
Phone (224) 505-5665

415 Washington St
Ste 200
Waukegan, IL 60085
Phone (224) 384-0060

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727568000000",
    "number": "1720774359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 WASHINGTON ST STE 200",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855564",
            "telephone_number": "224-255-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 WASHINGTON ST STE 200",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855564",
            "telephone_number": "224-392-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOBON",
        "first_name": "MARIA",
        "middle_name": "CAMILA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-09-29",
        "certification_date": "2024-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.