Healthcare Provider Details

I. General information

NPI: 1639092414
Provider Name (Legal Business Name): JOSEPH MIRELES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ANTLER DR
CASPER WY
82601-1726
US

IV. Provider business mailing address

3501 NAVARRE RD
CASPER WY
82604-4876
US

V. Phone/Fax

Practice location:
  • Phone: 307-374-6463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1671
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: