Optum Behavioral Care of Colorado, P.C.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

OPTUM BEHAVIORAL CARE OF COLORADO, P.C.

Doing business as

Delta Center of Wisconsin

Practice address

196 3Rd St
Fond Du Lac, WI 54935-4418

Phone

(920) 733-2065

NPI assigned

Jan 24, 2024

Last updated

Apr 24, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leslie Johnson

Title

Ceo

Phone

(704) 506-6267

Specialties & licenses 1

Addresses

Other names 1

• Delta Center of Wisconsin Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • De Pere, WI
  • NPI 1396622494

  O20240429000918

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  dba Sherman Counseling of Wisconsin

  • Counseling Psychologist
  • Appleton, WI
  • NPI 1487424826

  O20240429000918

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  dba Baeten Counseling of Wisconsin

  • Counseling Psychologist
  • Green Bay, WI
  • NPI 1538921796

  O20240429000918

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  dba New Directions of Wisconsin

  • Counseling Psychologist
  • Stevens Point, WI
  • NPI 1639931892

  O20240429000918

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  dba Red Oak Counseling of Wisconsin

  • Clinical Psychologist
  • Elm Grove, WI
  • NPI 1750151189

  O20240429000918

  Same enrollment

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Dombeck, APNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Winnebago, WI
  • NPI 1487163184
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1104688365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "704-506-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 3RD ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354418",
            "telephone_number": "920-733-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-506-6267"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Center of Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lorrie Ann Olig, SAC
• Matthew Olig
• John F. Olson, P.T.
• Nora L Olson, M.D.
• Susan M Olszewski, FNP-BC APNP
• Oral Surgery Assoc LTD
• Morgan Jeane Orsburne, APNP
• Orthopedic & Sports Medicine Specialists of Green Bay, SC
• Marne Kelley Osborn
• Jacklyn R Osborne, NP

• Counseling Psychologist in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Counseling Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.