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General NPI Number Information
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NPI Number | 1568272698
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Entity Type | Organization
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Legal Business Name | OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2450 S WHITE MOUNTAIN RD STE 3
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City | SHOW LOW
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State | AZ
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Zip | 85901-7384
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Country | US
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Telephone | 928-985-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 S WHITE MOUNTAIN RD STE 3
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City | SHOW LOW
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State | AZ
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Zip | 85901-7384
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LESLIE FUCHS
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Credential |
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Telephone | 810-358-1643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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