Healthcare Provider Details

I. General information

NPI: 1447137542
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 W EMERALD ST
BOISE ID
83704-8205
US

IV. Provider business mailing address

8800 W EMERALD ST
BOISE ID
83704-8205
US

V. Phone/Fax

Practice location:
  • Phone: 877-622-0013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KERRY BISCORNET
Title or Position: SECRETARY
Credential:
Phone: 603-854-2929