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General NPI Number Information
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NPI Number | 1790504553
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Entity Type | Organization
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Legal Business Name | VEN MENTAL HEALTH VERO BEACH, LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 847 20TH PL
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City | VERO BEACH
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State | FL
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Zip | 32960-5357
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Country | US
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Telephone | 402-991-9630
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Fax |
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Provider Business Mailing Address
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Address Line | 13917 GOLD CIR
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City | OMAHA
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State | NE
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Zip | 68144-2359
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Country | US
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Telephone | 402-991-9630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VITHYALAKSHMI SELVARAJ
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Credential | MD
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Telephone | 402-991-9630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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