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General NPI Number Information
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NPI Number | 1396289955
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Entity Type | Organization
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Legal Business Name | STEL, LLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 520 S 3RD ST STE 12
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City | CARBONDALE
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State | CO
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Zip | 81623-2059
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Country | US
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Telephone | 855-925-5267
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Fax |
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Provider Business Mailing Address
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Address Line | 989 S MAIN ST STE A #455
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4602
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Country | US
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Telephone | 855-925-5267
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Fax | 855-920-8038
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Authorized Official
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Title or Position | CIO/OWNER
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Name | MR. ROBERT EDWARD MOCKLEY II
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Credential |
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Telephone | 970-366-0494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1825-00
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License Number State | CO
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