MEDICARE: OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1427823749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC

Provider Business Mailing Address
First Line	:	11000 OPTUM CIR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2503
Country	:	US
Telephone Number	:	704-506-6267
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 CARMEL EXECUTIVE PARK DR STE 155
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8242
Country	:	US
Telephone Number	:	828-350-1177
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	VIRGINIA MARIE STEELMAN
Credential	:
Telephone Number	:	704-506-6267

Provider Enumeration Date	:	11/16/2023
Last Update Date	:	11/16/2023

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