Individual
LARA N MIKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
417 S 6TH ST, BOISE, ID 83702-7632
(208) 577-4465
(208) 577-4469
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW43846
ID
104100000X
Social Worker
LMSW 33502
ID
Other
Enumeration date
08/26/2014
Last updated
03/25/2024
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