Healthcare Provider Details

I. General information

NPI: 1770336521
Provider Name (Legal Business Name): OPAL THERAPY FOR HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/23/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W BITTERSWEET PLACE UNIT 412
CHICAGO IL
60613
US

IV. Provider business mailing address

1440 W TAYLOR ST # 1718
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 872-356-1377
  • Fax:
Mailing address:
  • Phone: 872-356-1377
  • 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: MEAGAN MARSH
Title or Position: FOUNDER AND THERAPIST
Credential: LCSW
Phone: 872-356-1377