Provider Demographics
NPI:1942076633
Name:OPTUM BEHAVIORAL CARE OF OHIO, INC
Entity Type:Organization
Organization Name:OPTUM BEHAVIORAL CARE OF OHIO, INC
Other - Org Name:SUNDANCE BEHAVIORAL RESOURCES OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISCORNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-854-2929
Mailing Address - Street 1:11000 OPTUM CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2503
Mailing Address - Country:US
Mailing Address - Phone:608-854-2929
Mailing Address - Fax:
Practice Address - Street 1:310 E 4500 S STE 600
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4246
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:801-265-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty