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General NPI Number Information
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NPI Number | 1871454140
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Entity Type | Organization
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Legal Business Name | BOMBADIL BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 128 S CONSTITUTION ST
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City | EMPORIA
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State | KS
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Zip | 66801-4621
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Country | US
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Telephone | 620-366-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 128 S CONSTITUTION ST
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City | EMPORIA
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State | KS
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Zip | 66801-4621
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Country | US
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Telephone | 620-366-9444
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JENNIFER GILLENWATER
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Credential | LMSW, LAC
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Telephone | 620-366-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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