Individual
JONATHAN ROY MINKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
2020 BLAINE STREET, CALDWELL, ID 83605
(208) 453-2840
(208) 453-2840
Mailing address
11648 EVA LANE, CALDWELL, ID 83607-9716
(208) 453-2840
(208) 453-2840
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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