Healthcare Provider Details

I. General information

NPI: 1811761240
Provider Name (Legal Business Name): OPTIMUM QUALITY BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 ORRINGTON AVE STE 600
EVANSTON IL
60201-3860
US

IV. Provider business mailing address

1603 ORRINGTON AVE
EVANSTON IL
60201-3841
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-2099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOMILOLA ADEWOLU
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-461-0977