Individual provider · Type 1 NPI

Leo Mironovich

Professional Counselor · Nampa, ID

NPI number 1194517417 Active

Practice location

9850 W St Lukes Dr Ste 320
Nampa, ID 83687-7912

Call (208) 505-2222 Map

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X3271766 (ID)

Professional Counselor: Definition to come...

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About NPI 1194517417

Leo Mironovich's National Provider Identifier is 1194517417, issued on May 21, 2025. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Nampa, ID. The record was last updated on Jun 16, 2025.