Provider Demographics
NPI:1316781735
Name:STONEWALL BEHAVIORAL HEALTH & MENTAL WELLNESS
Entity type:Organization
Organization Name:STONEWALL BEHAVIORAL HEALTH & MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-354-8410
Mailing Address - Street 1:826 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3246
Mailing Address - Country:US
Mailing Address - Phone:765-354-8410
Mailing Address - Fax:
Practice Address - Street 1:826 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3246
Practice Address - Country:US
Practice Address - Phone:541-539-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health