NPIMap

Organization Active NPI

Stellar Clinic CT PLLC

  • Mental Health Counselor
  • Detroit, MI
National Provider Identifier
1609641042
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
STELLAR CLINIC CT PLLC
Practice address
220 W Congress St
Detroit, MI 48226-3289
Phone
(734) 584-0133
Fax
(844) 333-0460
NPI assigned
Nov 15, 2023
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George Wang
Title
Administrator
Phone
(248) 313-8413

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X

Addresses

Primary practice location

220 W Congress St
Detroit, MI 48226-3289

Mailing address

440 N Barranca Ave # 4885
Covina, CA 91723-1722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, MI, NC, IL, TX, CO, MD7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20240212001858 VA Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 25 practitioners
Practice locations: Richmond, VA
O20240321001464 MI Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 12 practitioners
Practice locations: Detroit, MI
O20250519000983 NC Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 5 practitioners
Practice locations: Raleigh, NC
O20250519001528 IL Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 10 practitioners
Practice locations: Chicago, IL
O20250604002214 TX Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 10 practitioners
Practice locations: Houston, TX
O20250605000517 CO Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 9 practitioners
Practice locations: Denver, CO
O20250605003446 MD Part B Supplier - Clinic/Group Practice 0840633368 Receives reassigned benefits from 2 practitioners
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

Locations

870 S Colorado Blvd
#1067
Denver, CO 80246
Phone (248) 704-5837

111 N Wabash Ave
Chicago, IL 60602
Phone (248) 704-5837

822 Guilford Ave
#1484
Baltimore, MD 21202
Phone (443) 390-8333

220 W Congress St
Unit 759
Detroit, MI 48226
Phone (415) 343-5839

9500 SW Barbur Blvd
Ste 100
Portland, OR 97219

1806 Summit Ave
#300199
Richmond, VA 23230
Phone (415) 343-5839

Practitioners & affiliated clinicians

Practitioners 70

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 70

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1609641042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 N BARRANCA AVE # 4885",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W CONGRESS ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482263289",
            "telephone_number": "734-584-0133",
            "fax_number": "844-333-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLAR CLINIC CT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-313-8413"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.