NPIMap

Organization Active NPI

Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Seattle, WA
National Provider Identifier
1114797545
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
OPTUM BEHAVIORAL CARE OF COLORADO, P.C.
Practice address
1307 N 45TH St Ste 200
Seattle, WA 98103-6741
Phone
(704) 506-6267
NPI assigned
Jan 5, 2024
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1307 N 45TH St Ste 200
Seattle, WA 98103-6741

Mailing address

67 Burnside Ave
East Hartford, CT 06108-3408
Phone (704) 506-6267

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241017002871 WA Part B Supplier - Clinic/Group Practice 0941648463 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

12025 115th Ave NE
Ste 200
Kirkland, WA 98034
Phone (425) 821-1810

203 W Patison St
Ste D
Port Hadlock, WA 98339
Phone (360) 698-4860

450 S Kitsap Blvd
Ste 260
Port Orchard, WA 98366
Phone (360) 698-4860

16150 NE 85th St
Ste 121
Redmond, WA 98052
Phone (425) 868-5777

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1114797545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 BURNSIDE AVE",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083408",
            "telephone_number": "704-506-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 N 45TH ST STE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036741",
            "telephone_number": "704-506-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "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": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.