Healthcare Provider Details

I. General information

NPI: 1952177644
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E BROAD ST STE 301
COLUMBUS OH
43215-4037
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 614-674-6076
  • Fax: 614-674-6076
Mailing address:
  • Phone:
  • 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