Optum Behavioral Care of Colorado, P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

OPTUM BEHAVIORAL CARE OF COLORADO, P.C.

Practice address

670 Hawthorne Ave SE Ste 40
Salem, OR 97301-6884

Phone

(503) 316-6770

NPI assigned

Jan 8, 2024

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

Medicare fee-for-service enrollment

Enrolled in OR

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 Psychologist
  • Beaverton, OR
  • NPI 1225890460

  O20240827003465

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

  • Clinical Psychologist
  • Eugene, OR
  • NPI 1316717747

  O20240827003465

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

  • Clinical Social Worker
  • Lake Oswego, OR
  • NPI 1689551780

  O20240827003465

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

  • Professional Counselor
  • Portland, OR
  • NPI 1710711080

  O20240827003465

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

  • Clinical Psychologist
  • Corvallis, OR
  • NPI 1861262297

  O20240827003465

  Same enrollment

Locations

Practitioners 1

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

• Paul Dudziak

  • Clinical Social Worker
  • Portland, OR
  • NPI 1851850069
  NPD

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1144090465",
    "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": "670 HAWTHORNE AVE SE STE 40",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016884",
            "telephone_number": "503-316-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "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": []
}

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• Clinical Psychologist in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.