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General NPI Number Information
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NPI Number | 1417803966
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Entity Type | Organization
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Legal Business Name | OPAL MENTAL WELLNESS PLLC
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Dates
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Enumeration Date | 03/07/2026
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Last Update Date | 03/07/2026
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Provider Practice Location Address
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Address Line | 14623 NE N WOODINVILLE WAY STE 104
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City | WOODINVILLE
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State | WA
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Zip | 98072-8475
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Country | US
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Telephone | 425-264-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 23322 25TH DR SE
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City | BOTHELL
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State | WA
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Zip | 98021-9536
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Country | US
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Telephone | 605-521-4974
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | REBEKAH R HAGE
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Credential | MSW LICSW
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Telephone | 425-264-4245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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