Healthcare Provider Details

I. General information

NPI: 1669305314
Provider Name (Legal Business Name): STOVALL PSYCHIATRIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 560
BEAVERTON OR
97005-4791
US

IV. Provider business mailing address

10700 SW BEAVERTON HILLSDALE HWY STE 560
BEAVERTON OR
97005-4791
US

V. Phone/Fax

Practice location:
  • Phone: 986-270-4780
  • Fax: 986-234-7669
Mailing address:
  • Phone: 986-270-4780
  • Fax: 986-234-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAYMIE STOVALL
Title or Position: ARNP
Credential: PMHNP-BC
Phone: 986-270-4780