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General NPI Number Information
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NPI Number | 1275391724
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Entity Type | Organization
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Legal Business Name | VENTURE MENTAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 8915 SW OXBOW TER
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City | BEAVERTON
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State | OR
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Zip | 97008-6901
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Country | US
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Telephone | 503-248-7671
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Fax |
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Provider Business Mailing Address
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Address Line | 8915 SW OXBOW TER
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City | BEAVERTON
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State | OR
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Zip | 97008-6901
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Country | US
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Telephone | 503-248-7671
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DAVID GELDERT
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Credential | PMHNP
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Telephone | 407-342-8092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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