Healthcare Provider Details

I. General information

NPI: 1053181487
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 HIGHWAY 55
MINNEAPOLIS MN
55441-6300
US

IV. Provider business mailing address

67 BURNSIDE AVE
EAST HARTFORD CT
06108-3408
US

V. Phone/Fax

Practice location:
  • Phone: 704-506-6267
  • Fax:
Mailing address:
  • Phone: 704-506-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE JOHNSON
Title or Position: CEO
Credential:
Phone: 704-506-6267