NPIMap

Organization Active NPI

Optum Behavioral Care of Colorado, P.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plymouth, MI
National Provider Identifier
1114784451
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Practice address
705 S Main St Ste 280
Plymouth, MI 48170-1060
Phone
(734) 454-3560
NPI assigned
Mar 4, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

705 S Main St Ste 280
Plymouth, MI 48170-1060

Mailing address

11000 Optum Cir
Eden Prairie, MN 55344-2503
Phone (734) 454-3560

Other practice location 1

5841 Whitmore Lake Rd Ste A
Brighton, MI 48116-1991
Phone (734) 454-3560

Other practice location 2

31000 Telegraph Rd Ste 120
Bingham Farms, MI 48025-4321
Phone (248) 594-4991

Other practice location 3

1785 W Stadium Blvd Ste 205
Ann Arbor, MI 48103-5285
Phone (734) 913-1093

Other practice location 4

3300 Washtenaw Ave Ste 265
Ann Arbor, MI 48104-4200
Phone (734) 822-4810

Other names 1

  • Heron Ridge Associates of Michigan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240412001576 MI Part B Supplier - Clinic/Group Practice 0941648463 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ann Arbor, MI; Bingham Farms, MI; Brighton, MI; Plymouth, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral of Co PC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Locations

1785 W Stadium Blvd
Ste 205
Ann Arbor, MI 48103
Phone (734) 787-9775

3300 Washtenaw Ave
Ste 265
Ann Arbor, MI 48104
Phone (734) 822-4810

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1114784451",
    "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": "734-454-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 S MAIN ST STE 280",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701060",
            "telephone_number": "734-454-3560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5841 Whitmore Lake Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481161991",
            "country_code": "US",
            "telephone_number": "734-454-3560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31000 Telegraph Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Bingham Farms",
            "state": "MI",
            "postal_code": "480254321",
            "country_code": "US",
            "telephone_number": "248-594-4991",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1785 W Stadium Blvd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481035285",
            "country_code": "US",
            "telephone_number": "734-913-1093",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3300 Washtenaw Ave Ste 265",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481044200",
            "country_code": "US",
            "telephone_number": "734-822-4810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heron Ridge Associates of Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.