| Mr Bobby Joe Leebold, LCSW | |
| 
					808 S Eldorado Rd, Suite 102, Bloomington, IL 61704-6071  | |
| (309) 310-4636 | |
| Not Available | 
| Full Name | Mr Bobby Joe Leebold | 
|---|---|
| Gender | Male | 
| Speciality | Social Worker - Clinical | 
| Location | 808 S Eldorado Rd, Bloomington, Illinois | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1164728127 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149-013270 (Illinois) | Primary | 
| Entity Name | The Robert Young Center For Community Mental Health | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1710276399 PECOS PAC ID: 4587600150 Enrollment ID: O20220303002245  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Mr Bobby Joe Leebold, LCSW Po Box 604, Bloomington, IL 61702-0604 Ph: (309) 706-3190  | Mr Bobby Joe Leebold, LCSW 808 S Eldorado Rd, Suite 102, Bloomington, IL 61704-6071 Ph: (309) 310-4636  | 
Hannah Deterding,  Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 108 W Market St, Bloomington, IL 61701 Phone: 309-827-5351  | |
Sara Fidlow, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1003 Martin Luther King Dr, Bloomington, IL 61701 Phone: 309-827-6026  | |
Daniela Michelle Van Pelt, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 702 W Chestnut St, Bloomington, IL 61701 Phone: 888-924-3786 Fax: 309-820-3574  | |
Jaylene Taubert, MSW LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 712 E Empire St Ste 1, Bloomington, IL 61701 Phone: 309-310-2841  | |
Zoe Jane Baker, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 205 N Williamsburg Dr Ste A, Bloomington, IL 61704 Phone: 309-807-5077  | |
Beth Anne Vogel, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2810 Degarmo Dr, Bloomington, IL 61704 Phone: 309-310-6465  | |
Ms. Johanna Rayman, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 200 W Monroe St, Suite 301, Bloomington, IL 61701 Phone: 309-310-5453  |