Bobby Joe Leebold, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149-013270 Issued in IL

Practice address

808 S Eldorado Rd
Suite 102
Bloomington, IL 61704-6071

Phone

(309) 310-4636

NPI assigned

Feb 8, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• The Robert Young Center for Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rock Island, IL
  • NPI 1710276399
  Medicare reassignment NPD
• The Robert Young Center for Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moline, IL
  • NPI 1912158494
  NPD
• The Robert Young Center for Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Muscatine, IA
  • NPI 1063224426
  NPD

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297123200000",
    "number": "1164728127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617020604",
            "telephone_number": "309-706-3190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S ELDORADO RD",
            "address_2": "SUITE 102",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046071",
            "telephone_number": "309-310-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEEBOLD",
        "first_name": "BOBBY",
        "middle_name": "JOE",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-08",
        "last_updated": "2011-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-013270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Deshea Lee, CST/CFA
• Anita C Lee, M.D.
• Dennis Lee, M.D.
• Ji P Lee, MD
• Karen M Lee, LCPC
• Bobbie JH Leeds
• Emma N Lemmel
• Len Childers LCSW Counseling Services, PLLC
• Kyle Lenihan
• Wilbert M. Leonard, D.P.M.

• Clinical Social Worker in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.