NPIMap

Organization Active NPI

Stellar Mental Health & Mediation, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Nampa, ID
National Provider Identifier
1902225436
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
STELLAR MENTAL HEALTH & MEDIATION, LLC
Practice address
923 16TH Ave S
Nampa, ID 83651-4731
Phone
(208) 639-1514
Fax
(208) 639-2301
NPI assigned
Apr 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Jeffrey Ryan Moreno, LSCW
Title
Owner/Program Manager
Phone
(208) 639-1514

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

923 16TH Ave S
Nampa, ID 83651-4731

Mailing address

923 16TH Ave S
Nampa, ID 83651-4731
Phone (208) 639-1514

Other practice location 1

3904 E Flamingo Ave
Nampa, ID 83687-3102
Phone (208) 570-8894

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150715000338 ID Part B Supplier - Clinic/Group Practice 5193038552 Receives reassigned benefits from 4 practitioners
Practice locations: Nampa, ID

National Provider Directory

National Provider Directory

Locations

320 11th Ave S
#112016
Nampa, ID 83651

5700 E Franklin Rd
Ste 250
Nampa, ID 83687
Phone (208) 570-8894

923 16th Ave S
Ste 200
Nampa, ID 83651
Phone (208) 639-1514

3904 E Flamingo Ave
Nampa, ID 83687
Phone (208) 467-7600

923 16th Ave S
Nampa, ID 83651
Phone (208) 639-1514

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1902225436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "923 16TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514731",
            "telephone_number": "208-639-1514",
            "fax_number": "208-639-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 16TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514731",
            "telephone_number": "208-639-1514",
            "fax_number": "208-639-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3904 E Flamingo Ave",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873102",
            "country_code": "US",
            "telephone_number": "208-570-8894",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STELLAR MENTAL HEALTH & MEDIATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-14",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER/PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-639-1514",
        "authorized_official_credential": "LSCW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.