Provider Demographics
NPI:1396486452
Name:OPAL HOLISTIC HEALTH, PLLC
Entity type:Organization
Organization Name:OPAL HOLISTIC HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-540-7855
Mailing Address - Street 1:124 PEARL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5374
Mailing Address - Country:US
Mailing Address - Phone:904-540-7855
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST STE 205
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5374
Practice Address - Country:US
Practice Address - Phone:904-540-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPAL HOLISTIC HEALTH, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty