Brian Keith Boles – Professional Counselor

Key facts

NPI: 1912376575
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 1705 (WY)
Practice address: 1430 Wilkins Cir
Casper, WY 82601-1336
Phone: (307) 237-9583
Fax: (307) 265-7277
NPI assigned: Sep 24, 2015
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Joseph Yeretsian, P.C. Mental Health Clinic/Center (Including Community Mental Health Center) · Boulder, CO · NPI 1942668165

Medicare reassignment Care Compare group NPD CO

Medicare Care Compare profile

Specialty: Mental Health Counselor
Education: Other, 2014
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Joseph Yeretsian PC (13 clinicians)

Practice addresses (Care Compare)

155 Boardwalk Dr
Suite 400
Fort Collins, CO 80525-3040
Phone (970) 549-0235

4770 Baseline Rd
Suite 300
Boulder, CO 80303-2669
Phone (720) 798-4516

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240905003763	CO	Practitioner - Mental Health Counselor	3274073143	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
1705	WY	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Joseph Yeretsian, P.C.		Current since Aug 22, 2024	Accepting new patients

Locations

4770 Baseline Rd
Ste 300
Boulder, CO 80303
Phone (720) 798-4516

155 Boardwalk Dr
Ste 400
Fort Collins, CO 80525
Phone (970) 549-0235

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	1705	WY	Yes

Addresses

Primary practice location

1430 Wilkins Cir
Casper, WY 82601-1336

Mailing address

1430 Wilkins Cir
Casper, WY 82601-1336
Phone (307) 237-9583

Other providers in Casper, WY

Remie Blythe, DO
Jaime Rose Bobinmyer-Hornecker, PHARM.D.
Body N Motion
Karl Edward Boehm, DO
Bokbh LLC
Jeneil Boles
Mary C Boltz, RN
Anna Jean Bond, RN
Daniel Ryan Bonifield, D.O.
Angela Lee Booth, APRN

All providers in Casper, WY · Professional Counselor in Wyoming

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.