| Optum Behavioral Care Of Colorado, P.c. | |
|
4753 N Broadway St Ste 403 Chicago IL 60640-7910 | |
| (704) 506-6267 | |
| Not Available |
| Full Name | Optum Behavioral Care Of Colorado, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 4753 N Broadway St Ste 403, Chicago, Illinois |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optum Behavioral Care Of Colorado, P.c. 67 Burnside Ave East Hartford CT 06108-3408 Ph: (704) 506-6267 | Optum Behavioral Care Of Colorado, P.c. 4753 N Broadway St Ste 403 Chicago IL 60640-7910 Ph: (704) 506-6267 |
| NPI Number | 1023888450 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 01/05/2024 |
| Certification Date | 01/05/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240717003350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023888450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Margarita Kos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477974525 PECOS PAC ID: 4789817099 Enrollment ID: I20140512000379 |
| Provider Name | Aloha P Leblanc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437665411 PECOS PAC ID: 1456613504 Enrollment ID: I20180329001508 |
| Provider Name | Mai Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225491954 PECOS PAC ID: 9032404637 Enrollment ID: I20200929000190 |
| Provider Name | Justin C Lam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265894786 PECOS PAC ID: 0143502492 Enrollment ID: I20200929000208 |
| Provider Name | Jennifer Lam Phan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376003509 PECOS PAC ID: 0244691863 Enrollment ID: I20241014003473 |
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