| Stellar Mental Health & Mediation, Llc | |
|
923 16th Ave S Nampa ID 83651-4731 | |
| (208) 639-1514 | |
| (208) 639-2301 |
| Full Name | Stellar Mental Health & Mediation, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 923 16th Ave S, Nampa, Idaho |
| Authorized Official Name and Position | Jeffrey Ryan Moreno (OWNER/PROGRAM MANAGER) |
| Authorized Official Contact | 2086391514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stellar Mental Health & Mediation, Llc 923 16th Ave S Nampa ID 83651-4731 Ph: (208) 639-1514 | Stellar Mental Health & Mediation, Llc 923 16th Ave S Nampa ID 83651-4731 Ph: (208) 639-1514 |
| NPI Number | 1902225436 |
|---|---|
| Provider Enumeration Date | 04/14/2014 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Medicare PECOS PAC ID | 5193038552 |
|---|---|
| Medicare Enrollment ID | O20150715000338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902225436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Ryan Moreno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083983514 PECOS PAC ID: 4981917341 Enrollment ID: I20150720003078 |
| Provider Name | Michelle Chin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649645938 PECOS PAC ID: 9133421423 Enrollment ID: I20160104001128 |
| Provider Name | Jynnah Leigh Snow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437622776 PECOS PAC ID: 1658611090 Enrollment ID: I20190320003135 |
| Provider Name | Jessica L Chilcott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104248194 PECOS PAC ID: 6800212721 Enrollment ID: I20200818003224 |
| Provider Name | Jenny M Pinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407102056 PECOS PAC ID: 3971598251 Enrollment ID: I20210817003892 |
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