Healthcare Provider Details

I. General information

NPI: 1265360564
Provider Name (Legal Business Name): OPAL PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 N HAMILTON AVE APT 1
CHICAGO IL
60618-8467
US

IV. Provider business mailing address

3436 N HAMILTON AVE APT 1
CHICAGO IL
60618-8467
US

V. Phone/Fax

Practice location:
  • Phone: 312-970-1087
  • Fax:
Mailing address:
  • Phone: 312-970-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH MICHELLE MCQUISTON
Title or Position: OWNER
Credential: LCSW
Phone: 312-970-1087