Healthcare Provider Details

I. General information

NPI: 1811678303
Provider Name (Legal Business Name): KYLE JEROME VENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CAMBRIDGE CT STE 219
AUBURN HILLS MI
48326-2514
US

IV. Provider business mailing address

2701 CAMBRIDGE CT STE 219
AUBURN HILLS MI
48326-2514
US

V. Phone/Fax

Practice location:
  • Phone: 248-648-0985
  • Fax:
Mailing address:
  • Phone: 248-648-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: