Provider Demographics
NPI:1013466952
Name:STEL, LLC
Entity Type:Organization
Organization Name:STEL, LLC
Other - Org Name:A NEW PATH MARIN, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CIO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOCKLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:970-366-0494
Mailing Address - Street 1:989 S MAIN ST STE A
Mailing Address - Street 2:#455
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4602
Mailing Address - Country:US
Mailing Address - Phone:855-925-5267
Mailing Address - Fax:
Practice Address - Street 1:863 FRANCISCO BLVD E STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4782
Practice Address - Country:US
Practice Address - Phone:855-925-5267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210047AP261QR0405X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder