| Optum Behavioral Care Of Colorado, P.c. | |
|
4121 E Valley Auto Dr Mesa AZ 85206-4631 | |
| (704) 506-6267 | |
| Not Available |
| Full Name | Optum Behavioral Care Of Colorado, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 4121 E Valley Auto Dr, Mesa, Arizona |
| 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. 11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (704) 506-6267 | Optum Behavioral Care Of Colorado, P.c. 4121 E Valley Auto Dr Mesa AZ 85206-4631 Ph: (704) 506-6267 |
| NPI Number | 1942070370 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240717001855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942070370 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael C Rockwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083655195 PECOS PAC ID: 3971572868 Enrollment ID: I20061102000596 |
| Provider Name | Cara L Quade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437112240 PECOS PAC ID: 9537239058 Enrollment ID: I20080610000091 |
| Provider Name | Bethany L Bartlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043565724 PECOS PAC ID: 8325299266 Enrollment ID: I20121127000264 |
| Provider Name | Eva R Besmanoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598062275 PECOS PAC ID: 5597981589 Enrollment ID: I20140728002678 |
| Provider Name | Joseph Peter Tris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881946978 PECOS PAC ID: 5698027142 Enrollment ID: I20181010002457 |
| Provider Name | Dustin Husemann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548756794 PECOS PAC ID: 0749534980 Enrollment ID: I20181107000596 |
| Provider Name | Mary Elizabeth (beth) Piraino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134605868 PECOS PAC ID: 8820405426 Enrollment ID: I20210326001503 |
| Provider Name | Nikka Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962939454 PECOS PAC ID: 4082040928 Enrollment ID: I20210819003588 |
| Provider Name | Samantha Lynne Kragel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215694773 PECOS PAC ID: 4385035518 Enrollment ID: I20211227000144 |
| Provider Name | Christina Demuro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659039766 PECOS PAC ID: 8022400902 Enrollment ID: I20220126003298 |
| Provider Name | Krystle M Brunker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376287052 PECOS PAC ID: 3173994985 Enrollment ID: I20240716002508 |
| Provider Name | Rebecca L Reza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689002404 PECOS PAC ID: 1456882554 Enrollment ID: I20240930003845 |
| Provider Name | Krystine Garcia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982357919 PECOS PAC ID: 6709311319 Enrollment ID: I20241119004225 |
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