Individual ProviderJesse A MirSocial WorkerBehavioral Health & Social Service ProvidersPractice Address204 Mccollum St Ste 201, Laramie, WY 82070-5127(973) 873-8432PECOS EnrollmentBased on the most recent information from CMS, provider Jesse A Mir does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:54 AM.Profile DetailsProvider ID1205663036Provider TypeIndividualFull NameMir, Jesse ACredentialLCSWGenderMaleSole ProprietorYesEnumeration Date9/16/2024Last Updated9/16/2024Contact InformationPractice LocationPractice Address204 Mccollum St Ste 201, Laramie, WY 82070-5127Phone(973) 873-8432FaxUnlisted FaxMailing LocationMailing Address402 Corthell Rd, Laramie, WY 82070-4875Phone(973) 873-8432FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLCSW-1625WyomingCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense44SC06261200New Jersey