Healthcare Provider Details

I. General information

NPI: 1831962265
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 POYDRAS ST STE 1950
NEW ORLEANS LA
70130-3341
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 504-322-3837
  • Fax:
Mailing address:
  • Phone: 603-854-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

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