Healthcare Provider Details

I. General information

NPI: 1790653392
Provider Name (Legal Business Name): STONEWALL BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 SE 10TH ST
PENDLETON OR
97801-3246
US

IV. Provider business mailing address

826 SE 10TH ST
PENDLETON OR
97801-3246
US

V. Phone/Fax

Practice location:
  • Phone: 503-503-9003
  • Fax:
Mailing address:
  • Phone: 503-503-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATHAN T SMITH
Title or Position: PRESIDENT
Credential: LCSW
Phone: 541-694-8189