Healthcare Provider Details

I. General information

NPI: 1497517676
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 GREEN RD STE 112
BEACHWOOD OH
44122-5715
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 216-896-0111
  • Fax:
Mailing address:
  • Phone: 216-896-0111
  • 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: 608-854-2929