Provider Demographics
NPI:1447072707
Name:BOYLE-MILROY, LESLIE (LAMFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BOYLE-MILROY
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3849 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3438
Mailing Address - Country:US
Mailing Address - Phone:605-760-3413
Mailing Address - Fax:
Practice Address - Street 1:1101 E 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1402
Practice Address - Country:US
Practice Address - Phone:952-854-5034
Practice Address - Fax:952-854-5363
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist