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General NPI Number Information
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NPI Number | 1790653392
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Entity Type | Organization
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Legal Business Name | STONEWALL BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 826 SE 10TH ST
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City | PENDLETON
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State | OR
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Zip | 97801-3246
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Country | US
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Telephone | 503-503-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 826 SE 10TH ST
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City | PENDLETON
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State | OR
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Zip | 97801-3246
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Country | US
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Telephone | 503-503-9003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHAN T SMITH
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Credential | LCSW
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Telephone | 541-694-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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