Healthcare Provider Details

I. General information

NPI: 1992679856
Provider Name (Legal Business Name): VEN MENTAL HEALTH AND TMS SERVICES OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N MORRISON ST STE 200
APPLETON WI
54911-5472
US

IV. Provider business mailing address

120 N MORRISON ST STE 200
APPLETON WI
54911-5472
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-9630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: VITHYALAKSHMI SELVARAJ
Title or Position: OWNER
Credential:
Phone: 402-991-9630