Healthcare Provider Details

I. General information

NPI: 1639931892
Provider Name (Legal Business Name): OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5541 US HIGHWAY 10 E STE B
STEVENS POINT WI
54482-8308
US

IV. Provider business mailing address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-2065
  • Fax: 920-733-6565
Mailing address:
  • Phone: 704-506-6267
  • 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: LESLIE JOHNSON
Title or Position: CEO
Credential:
Phone: 704-506-6267