Healthcare Provider Details

I. General information

NPI: 1790608719
Provider Name (Legal Business Name): BLACK OPAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N PLEASANT LAKE RD
EVELETH MN
55734-4088
US

IV. Provider business mailing address

3815 N PLEASANT LAKE RD
EVELETH MN
55734-4088
US

V. Phone/Fax

Practice location:
  • Phone: 218-994-2639
  • Fax:
Mailing address:
  • Phone: 218-994-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JADA STRUMBELL GRABANSKI
Title or Position: OWNER
Credential: LMFT
Phone: 218-994-2639