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Individual
JONATHAN ROY MINKOFF
Active
Individual
JONATHAN ROY MINKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC-126
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017377
REGENCE BLUESHIELD OF ID
ID
01
—
Q4608
BLUE CROSS OF IDAHO
ID
Enumeration date
12/04/2006
Last updated
07/08/2007
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