MEDICARE: OPTUM BEHAVIORAL CARE OF COLORADO, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1023888450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM BEHAVIORAL CARE OF COLORADO, P.C.

Provider Business Mailing Address
First Line	:	67 BURNSIDE AVE
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3408
Country	:	US
Telephone Number	:	704-506-6267
Fax Number	:

Provider Business Practice Location Address
First Line	:	4753 N BROADWAY ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7910
Country	:	US
Telephone Number	:	704-506-6267
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LESLIE JOHNSON
Credential	:
Telephone Number	:	704-506-6267

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	03/24/2025

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