Provider Demographics
NPI:1710711080
Name:OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Entity type:Organization
Organization Name:OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-358-1643
Mailing Address - Street 1:3115 NE SANDY BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2777
Mailing Address - Country:US
Mailing Address - Phone:971-407-3930
Mailing Address - Fax:888-515-7502
Practice Address - Street 1:1306 NW HOYT ST STE 407
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2787
Practice Address - Country:US
Practice Address - Phone:971-407-3930
Practice Address - Fax:888-515-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty