Individual
LEO MIRONOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9850 W ST LUKES DR STE 320, NAMPA, ID 83687-7912
(208) 505-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3271766
ID
Other
Enumeration date
05/21/2025
Last updated
06/16/2025
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