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General NPI Number Information
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NPI Number | 1831962265
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Entity Type | Organization
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Legal Business Name | OPTUM BEHAVIORAL CARE OF VIRGINIA, INC.
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 400 POYDRAS ST STE 1950
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City | NEW ORLEANS
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State | LA
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Zip | 70130-3341
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Country | US
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Telephone | 504-322-3837
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Fax |
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Provider Business Mailing Address
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Address Line | 11000 OPTUM CIR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2503
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Country | US
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Telephone | 603-854-2929
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | KERRY BISCORNET
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Credential |
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Telephone | 603-854-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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