Individual
ALEXANDRA EVELYN BOPE MIONGOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
13477 W BLUEBONNET DR, BOISE, ID 83713-1341
(208) 254-1112
(208) 254-7014
Mailing address
13477 W BLUEBONNET DR, BOISE, ID 83713-1341
(208) 254-1112
(208) 254-7014
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
39725
ID
1041C0700X
Clinical Social Worker
Primary
8861353
ID
Other
Enumeration date
04/17/2023
Last updated
03/12/2026
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