Provider Demographics
NPI:1932511177
Name:TOMBLEY, KENNETH SCOTT (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:SCOTT
Last Name:TOMBLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 COUNTY ROAD 2630
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:MO
Mailing Address - Zip Code:65789-8113
Mailing Address - Country:US
Mailing Address - Phone:417-274-0469
Mailing Address - Fax:
Practice Address - Street 1:4670 COUNTY ROAD 2630
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:MO
Practice Address - Zip Code:65789-8113
Practice Address - Country:US
Practice Address - Phone:417-274-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011029173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional