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General NPI Number Information
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NPI Number | 1558785253
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Entity Type | Organization
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Legal Business Name | OPTUMUMHEALTHOUTCOMES
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Dates
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Enumeration Date | 02/16/2014
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 5104 N ORANGE BLOSSOM TRL SUITE 108
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City | ORLANDO
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State | FL
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Zip | 32810-1042
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Country | US
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Telephone | 407-394-7181
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Fax | 810-222-6666
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Provider Business Mailing Address
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Address Line | 4531 ARCH ST
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City | ORLANDO
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State | FL
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Zip | 32808-7805
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Country | US
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Telephone | 407-394-7181
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Fax | 810-222-6666
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TIMOTHY EDWARDS
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Credential |
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Telephone | 407-394-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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