Individual
JESSE A MIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
204 MCCOLLUM ST STE 201, LARAMIE, WY 82070-5127
(973) 873-8432
Mailing address
402 CORTHELL RD, LARAMIE, WY 82070-4875
(973) 873-8432
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
44SC06261200
NJ
1041C0700X
Clinical Social Worker
Primary
LCSW-1625
WY
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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